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QUIZ  QUESTIONS 


ON 


EMBRYOLOGY 


Operative  Dentistry  and  Dental 
Patkology 


WITH  APPENDIX  GIVING  ANSWERS  TO  SUCH  QUESTIONS  AS 
ARE  MARKED  WITH  A  *.     ALSO  A  DETAILED  DE- 
SCRIPTION  OF  METHOD  OF  CONSTRUCT- 
ING THE  HOLLOW  GOLD 
INLAY. 


FROM  LECTURES  BY 

PROF.  H.  B.  TILESTON,  M.  D..  D.  D.  S. 


LOUISVILLE  COLLEGE  OF  DENTISTRY. 

LOUISVILLE.  KY. 


PREFACE 


The  purpose  of  this  volume  of  questions  is  to  aid  the 
students  of  The  Louisville  College  of  Dentistry  in  their  study 
of  the  subjects  presented  in  the  lectures  by  the  professor  of 
Embryology,  Operative  Dentistry  and  Dental  Pathology. 

It  is  in  no  sense  intended  to  be  considered  a  text-book, 
nor  is  it  expected  that  It  will  take  the  place  of  text-books. 
On  the  contrary,  the  object  the  writer  has  had  in  mind  is 
to  encourage  the  extensive  use  of  text-books  by  the  students 
and  it  is  hoped  that  these  questions  will  but  prove  an  incen- 
tive and  a  guide  to  further  study  of  the  subjects  merely  out- 
lined in  this  volume. 

On  Embryology  the  student  is  recommended  to  the  careful 
study  of  the  chapters  in  Vol.  1  of  The  American  System  of 
Dentistry  on  Dental  Embryology  and  Histology  by  W.  Xavier 
Sudduth,  M.  D.,  D.  D.  S.,  and  to  chaper  II  in  the  work  on 
Operative  Dentistry  by  Dr.  John  Sayre  Marshall.  This  latter 
treatise  is  beautifully  illustrated  and  the  text  is  clear  and 
comprehensive. 

In  the  arranging  of  a  lecture  course  on  Operative  Dentistry 
tribute  has  been  levied  upon  the  writings  of  a  number  of 
authors  to  whom  acknowledgment  is  hereby  made.  The  chap- 
ters by  Dr.  Louis  Jack  in  The  American  System  of  Dentistry 
and  in  The  American  Text-Book  of  Operative  Dentistry  have 

3       •' 


been  especially  useful  to  the  writer  and  the  student  is  earn- 
estly recommended  to  a  careful  reading  and  study  of  Dr. 
Jack's  writings. 

In  preparing  lectures  on  Dental  Caries  the  writer  has  of 
course  depended  upon  the  original  work  of  Dr.  W.  D.  Miller 
of  Berlin  as  published  in  Vol.  1  of  The  American  System  of 
Dentistry  and  in  later  papers  by  Dr.  Miller,  appearing  from 
time  to  time  in  the  dental  magazines.  The  papers  by  Dr. 
Leon  Williams,  Dr.  G.  V.  Black  and  the  chapters  by  Dr.  J.  S. 
Marshall  in  his  Operative  Dentistry  have  also  been  drawn 
upon.  More  than  to  any  other  author,  however,  the  writer 
is  indebted  to  Dr.  G.  V.  Black,  whose  scientific  attainments 
and  painstaking  methods  have  enabled  him  to  present  a 
system  of  operative  procedures  in  cavity  preparation  and  fill- 
ing which  is  ideal  and  it  has  been  adopted  in  this  course  of 
lectures  on  these  subjects,  as  has  also  his  nomenclature. 
Unfortunately,  Dr.  Black's  work  has  never  been  compiled  in 
a  volume  that  could  be  adopted  as  a  text-book,  and  for  this 
reason  the  writer  has  quoted  largely  from  his  papers  as 
published  in  magazines,  in  the  Appendix  to  this  volume,  there 
being  no  book  to  which  the  student  could  be  referred. 

On  Dental  Pathology  the  course  of  lectures  follows  closely 
the  text  of  the  late  Dr.  Henry  H.  Burchard  in  his  work  on  Den- 
tal Pathology  and  Therapeutics,  recently  revised  by  Dr.  Otto 
E.  Inglis.  No  answers  to  questions  under  this  heading  are 
given  in  the  Appendix,  as  it  was  thought  best  to  refer  the 
student  to  Dr.  Burchard's  book  for  the  thorough  and  careful 
study  of  the  entire  subject. 

A  recent  work  by  Dr.  Elgin  MaWhinney  on  Oral  Pathology 
and  Therapeutics,  published  by  The  Consolidated  Dental 
Manufacturing  Co.,  Is  recommended  to  the  student  as  a  refer- 
ence book. 

4 


A  blank  page  is  left  opposite  each  page  of  questions  in  this 
quiz  book  for  the  convenience  of  the  student,  that  he  may 
note  briefly  such  answers  as  are  not  in  the  Appendix.  Only 
those  questions  designated  thus  *  are  answered  in  the  Ap- 
pendix. 

In  the  hope  that  this  compilation  of  questions  with  the 
Appendix  may  prove  helpful,  this  volume  is  affectionately 
dedicated  to  the  student  body  of  The  Louisville  College  of 
Dentistry. 

Louisville,  Ky.,  March  23,  1906. 


EMBRYOLOGY. 

1.  What  is  embryology? 

2.  What  is  histology? 

3.  What  does  a  cell  consist  of? 

4.  From  what  are  all  organized  beings  originally  developed? 

5.  Into  what  two  classes  are  organized  beings  divided  ac- 

cording to  manner  of  deposit  and  development  of  egg? 

6.  Define  each  term. 

7.  How  does  fecundated  egg  differ  from  ordinary  cell? 

8.  What  is  the  spot  in  a  fecundated  egg  containing  the  vi- 

tal principle  called? 

9.  Describe  what  takes  place  in  the  germinal  spot. 

10.  Into  what  two  layers  do  these  cells  arrange  themselves? 

11.  How  is  the  mesoblast  formed? 

12.  What  is  the  name  of  these  three  layers  of  cells?    What 

do  they  constitute? 

13.  What  class  of  tissues  are  developed  from  epiblast? 

14.  What  from  mesoblast? 

15.  What  from  hypoblast? 

16.  To  what  class  of  tissues  do  teeth  belong? 
]  7.     Name  divisions  of  epiblast. 

« 

18.  Which  constitute  the  Rete  Malpighii? 

19.  What  is  the  function  of  the  infant  layer? 

20.  What  takes  place  as  the  first  indication  of  the  beginning 

of  the  development  of  teeth? 

21.  How  is  the  dentinal  groove  formed? 

22.  Into  what  tissue  does  the  enamel  organ  or  infant  layer 

dip  down? 

C 


23.  What  form  does  it  take  first? 

24.  What  causes  enamel  cord  to  become  bulbous? 

25.  What  cells  are  proliferated  within  the  enamel  organ  sac 

or  pouch? 

26.  What  is  the  form  of  the  infant  cells  at  this  time? 

27.  What  is  the  form  of  epithelial  cells  in  the  bulbous  enam- 

el organ? 

28.  What  form  do  they  afterward  take? 

29.  What  now  makes  its  appearance  in  the  connective  tissue 

of  mesoblast? 

30.  What   change   of   form   in   enamel   organ   is    caused   by 

growth  of  papilla? 

31.  Describe  further  changes  that  take  place  in  enamel  or- 

gan. 

32.  How  is  outer  and  inner  tunic  formed? 

33.  What  specialized  cells   do  the  infant  layer  of  cells  be- 

come? 

34.  What  is  the  stratum  intermedium? 

35.  What  is  its  function? 

36.  What  is  the  dentinal  papilla  to  become? 

37.  What  now  begins  to  appear  in  the  connective  tissue  of 

mesoblast  outside  of  papilla? 

38.  What  is  contained  in  the  dental  follicle? 

39.  What  has  been  called  the  membrana  eboris? 

40.  What  is  the  connection  between  enamel  organ  and  pa- 

pilla? 

41.  What  is  the  name  of  specialized  cells  which  are  to  de- 

posit  enamel? 

42.  What  is  the  name  of  the  specialized    cells    to  deposit 

dentine? 

43.  Which  cells  appear  first? 

44.  Which  is  deposited  first,  enamel  or  dentin? 

7 


45.  Describe  method  of  deposit  of  enamel. 

46.  When  rods  are  completed,  what  change  takes  place  in 

ameloblasts,  and  what  do  they  become? 

47.  In  what  direction  does  enamel  grow? 

48.  In  what  direction  does  dentin  grow;  at  expense  of  what? 

49.  Are  ameloblasts  persistent? 

50.  Are  odontoblasts  persistent? 

51.  Describe  method  of  deposit  or  growth  of  dentin. 

52.  At  what  age  in  embryo  does  calcification  begin? 

53.  What  specialized  cells  are  involved  in  formation  of  ce- 

mentum? 

54.  Are  they  persistent? 

55.  Where   and   how   does   cord   for  permanent  teeth   origi- 

nate?    Spiral  form  of,  why? 

56.  What  are  interglobular  spaces  and  how  do  they  occur? 

57.  Do  enamel  cells  themselves  calcify? 

58.  What  substance  lies  between  enamel  rods?    Is  it  calcific 

or  vital? 

59.  Hardness  of  enamel  due  to  what? 

60.  Is  enamel  of  a  man's  tooth  harder  or  softer  than  wo- 

man's? 

61.  What  is  the  condition  of  temporary  teeth  as  to  extent  of 

calcification  at  birth? 

62.  At  what  age  are  all  complete? 

63.  What  becomes  of  roots  of  the  temporary  teeth?  • 

64.  What  organs  or  cells  effect  their  solution? 

65.  At  what  age  does  decalcification  of  temporary  roots  be- 

gin? 

66.  Is  it  advisable  to  lance  the  gums  over  temporary  tooth 

being  erupted  with  difficulty,  and  why? 

67.  What   is   the   condition   as   to   extent   of   calcification   of 

permanent  teeth  at  birth? 

8 


68.  Which  of  permanent  teeth  is  the  first  to  erupt? 

69.  What  is  the  extent  of  calcification  of  permanent  teeth 

at  ten  years?     Which  are  complete? 

70.  What  bearing  does  this   condition   have   upon   operative 

procedures  at  this  age? 

71.  What  is  condition  at  age  of  twelve? 

72.  What  is  histological  character  of  enamel? 

73.  What  of  dentin? 

74.  What  of  pulp? 

75.  What  three  forms  of  cells  found  in  pulp? 

76.  What  layer  of  cells  is  found  covering  periphery  of  pulp? 

77.  What  is  the  gum  tissue  composed  of? 

78.  Is  it  freely  supplied  with  sensory  nerve  fibres? 

79.  What  is  the  pericementum? 

80.  From  what  does  it  originate? 

81.  How  does  it  differ  from  gum  tissue? 

82.  What  is  the  direction  of  its  fibres? 

83.  What  are  its  five  functions? 

84.  Is  it  composed  of  one  or  two  membranes? 

85.  What  is  the  dental  ligament? 


DENTAL    HISTOLOGY. 


1.  Define  histology. 

2.  Define  dental  histology. 

3.  Name   the   tissues   of   which   a   tooth    is    made   up    and 

state  what  part  of  the  tooth  each  tissue  forms. 

4.  Do  teeth  belong  to  the  osseous  system? 

5.  In  what  system  of  tissues  are  teeth  classed? 

6.  What  is  Nasmyth's  memibrane? 

7.  Is  it  organic  or  inorganic   (calcic)?     How  proven? 

9 


8.  How  many  Nasmyth's  membrane,  or  the  cuticula  dentis, 

frequently  prove  a  source  of  danger  to  teeth  of  the 
young?* 

9.  What  is  the  chemical  composition  of  enamel?* 

10.  What  per  cent  of  enamel  is  organic  matter? 

11.  Of  what  structural  elements  is  enamel  made  up? 

12.  Describe    shape,    direction,    and    arrangement    of    the 

enamel  rods. 

13.  How  are  the  rods  held  together? 

14.  Is   the  intercement   substance     organic    or    inorganic? 

How  proven? 

15.  What  bearing  do  these  facts  have  upon  operative  pro- 

cedures in  cavity  preparation? 

16.  Etescribe  the  physical  structure  of  dentin. 

17.  What  is  the  shape  and  direction  of  the  dental  tubules? 

18.  What  do  the  tubules  contain  in  a  vital  tooth? 

19.  Where  is  the  origin  or  source  of  the  fibrils  found  in  the 

dental  tubules  known  as  Tome's  fibrils? 

20.  What  bearing  does  the  presence  of  these   fibrils   have 

upon   operative  procedures   in   cavity  preparation? 

21.  What  is  the  chemical  composition  of  dentin?* 

22.  What  is  the  proportion  of  organic  and  inorganic  matter 

in  dentin? 

23.  What  is  the  "granular  layer  of  Tomes"  and  where  is  it 

found? 

24.  What   effect   does   this   granular   layer   have   upon   the 

progress  of  caries? 

25.  What  is    secondary    dentin    and    how    and    under    what 

conditions  is  it  formed? 

26.  What  tissue  of  the  body  does  cementum  most  resemble? 

27.  How  does  it  differ  from  bone? 

28.  What  is  the  function  of  the  cementum? 

10 


29.  What  is  the  shape  of  the  pulp  in  young  teeth? 

30.  Of  what  tissues  is  the  pulp  made  up? 

31.  Where  are  the  odontoblastic  cells  found,  and  what  is 

their  function? 

32.  What  bearing  does  the  functional  activity  of  the  odon- 

toblasts have  upon  operative  procedures  in  cases  of 
deep-seated  caries? 

33.  What  are  the  functions  of  the  pulp?* 

34.  From  what  source  does  the  pulp  derive  its  blood  supply? 

35.  What  is  the  alveolo-dental  periosteum  and  where  is  it 

found? 

36.  Is  this  a  single  or  a  double  membrane?* 

37.  What  is  the  principal  function  of  this  membrane?* 

38.  What  is  the  vital  function  of  this  membrane?* 

39.  What  is  the  sensory  function  of  this  membrane?* 

40.  Of  what  structures  is  this  membrane  made  up?* 

41.  What  four  classes  of  cells  appear  in  this  membrane?* 

42.  Describe  the  arrangement  of  the  fibers  of  the  alveolo- 

dental  membrane  and  state  the  purpose  of  such  ar- 
rangement* 


AFFECTIONS    AND    DISEASES    OF    THE    HARD    DENTAL 

TISSUES. 

1.  May  enamel  properly  be  said  to, be  subject  to  diseased 

conditions? 

2.  If  not,  why  not? 

3.  What  are  the  affections  to  which  enamel  is  liable? 

4.  What  is  "mechanical  abrasion?" 

5.  Name   several  causes   or   sources   of   mechanical  abra- 

sion. 
G.     What  is  "erosion"  of  enamel? 

7.    How  does  erosion  differ  from  mechanical  abrasion? 

U 


8.  What  is  the  cause  of  erosion? 

9.  What  treatment  would  you  prescribe  for  erosion? 

10.  What   reparative   treatment    would    you    prescribe    for 

erosion  and  mechanical  abrasion? 

11.  What   are    enamel    stains    or    discolorations    and    name 

several  causes  of? 

12.  How  would  you  treat  enamel  stains? 

13.  What  is  "atrophy"  of  the  enamel  and  its  cause? 

14.  May  dentin  properly  be  said  to  be  subject  to  diseased 

conditions? 

15.  Give  a  reason  for  your  answer. 

16.  Into  what  two   general  divisions   may  diseases  of  the 

dentin  be  divided? 

17.  What  is  meant  by  a  "constructive  disease"  of  the  den- 

tin? 

18.  Where   is   the   secondary   dentin    deposited   in  this   af- 

fection of  the  dentin? 

19.  What  is  the  cause  of  this  diseased  condition? 

20.  What  is  meant  by  a  "destructive  disease"  of  the  dentin? 

21.  Name  several  destructive  diseases  of  the  dentin. 

22.  Destructive  diseases  are  divisible,  according  to  causa- 

tion, into  what  three  classes? 

23.  Name  those  due  primarily  to  chemical  action. 

25.  Name  one  due  primarily  to  the  action  of  physical  forces. 

26.  Name  one  due  to  vital  causes. 

27.  How  do  abrasion  and  erosion  differ  in  their  action  as 

to  rapidity,  in  enamel  and  dentin? 

28.  What  structural  change  in  the  dentin  is  associated  with 

erosion  and  abrasion?  ' 

29.  What  is  the  cause  of  resorption  of  dentin? 

30.  Does  resorption  operate  from  within  the  tooth  or  from 

the  exterior? 

— Reference:      Burchard's  Dental   Pathology  and 
Therapeutics. 

12 


CARieS. 

1.  Define  dental  caries.* 

2.  Does  it  have  its  beginning  on  the  surface  of  tooth  or 

within? 

3.  What  are  the  gradations  of  color  presented? 

4.  What  does  color  indicate  as  to  rapidity  of  progress? 

5.  Is  dental  caries  merely  a  condition  or  a  specific  disease? 

6.  *  Is  it  an  ancient  or  a  modern  disease? 

7.  How  ancient  is  it  supposed  to  be?* 

8.  What  were  some  of  the  earliest  theories  as  to  the  cause 

of  dental  caries?* 

9.  What  observations  disproved  the  vital  or  inflammatory 

theory? 

10.  How  was  the  electro-chemical  theory  disproved? 

11.  What  are  the  two  classes  of  causes  of  caries? 

12.  What  is  meant  by  a  predisposing  cause  of  a  disease? 

13.  What  is  meant  by  an  exciting  cause? 

14.  What  is  the  accepted  exciting  cause  of  dental  caries? 

15.  By  whose  experiments  was  this  theory  of  the  etiology 

of  dental  caries  demonstrated  to  be  true? 

16.  By  what  experiments  did  Prof.  W.  D.  Miller  prove  that 

the  acid  associated  with  dental  caries  was  produced 
by  an  organized  living  ferment?* 

17.  How   did   he  establish   the  fact   that  the  fermentative 

germ  resided  in  the  saliva  and  not  in  the  starch?* 

18.  How  did  he  prove  the  germ  to  be  reproductive?* 

19.  How  did  he  determine  the  acid  produced  to  be  lactic 

acid?* 

20.  Is  dental  caries  produced  by  a  specific  germ? 

21.  Out  of  eighteen  varieties  of  bacteria  examined  by  Prof. 

Miller  how  many  were  found  to  produce  lactic  acid? 

13 


22.  What  two   classes   of  fungi   operate   in   conjunction   to 

produce  dental  caries? 

23.  What  is  the  function  of  zymogenic  bacteria  in  the  pro- 

duction of  caries? 

24.  What  is  the  function  of  the  saprophytic  bacteria? 

25.  What  conditions  about  the  teeth  in  the  human  mouth 

favor  the  production  and  growth  of  micro-organisms 
of  caries? 

26.  Are  these  micro-organisms  animal  or  vegetable? 

27.  What   pabulum   or   food    substance   is    essential   to   the 

growth  of  the  fungus  of  caries? 

28.  What  is  the  chief  source  of  the  supply  of  sugar  from 

which  fungus  derives  its  nourishment? 

29.  Is  oxygen  necessary  to  its   existence? 

30.  If  oxygen  is  not  necessary  to  the  life  of  the  fungus,  why 

is  it  that  a  filling  which  excludes  air  and  moisture 
but  incloses  in  the  cavity  a  number  of  these  micro- 
organisms will  preserve  the  tooth  from  further  de- 
cay? 

31.  What  terms  are  used  to  designate  those  forms  of  bac- 

teria which  exist  with  or  without  oxygen?* 

32.  How   do   the   germs  of  caries   begin   their   attack  upon 

enamel  on  smooth  surfaces? 

33.  What  is  the  manner  of  attack  in  case  of  pits  and  fis- 

sures? 

34.  How   does    the   disease  progress    after    the  dentin    is 

reached  ? 

35.  What  is  the  effect  upon  the  dental  tubules? 

36.  Which    operates    in    advance — the    micro-organisms    or 

the  lactic  acid? 

37.  Name  some  forms  of  micro-organisms  found  in  carious 

matter. 

U 


38.  Wliat  is  the  effect  of  an  excess  of  lactic  acid  upon  the 

micro-organism? 

39.  What  influences  control  the  accumulation  of  an  excess 

of  acid? 

39.  What  is  the  essential  difference  between  chemical  abra- 

sion or  erosion  and  true  caries? 

40.  Name  some  predisposing  causes  of  caries.* 

41.  Name   several   constitutional   predisposing  causes.* 

42.  What  is  meant  by    faulty  formation?     What  are    two 

kinds  of? 

43.  Are   soft  teeth    (so-called)    more   predisposed   to   caries 

than  hard  teeth,  or  is  it  more  in  the  environment? 

44.  In  which   (hard  or  soft  teeth)   will  progress  of  caries, 

when  once  begim,  be  most  rapid? 

45.  How  does  manner  of  proximate  contact  affect  liability 

to  caries? 

46.  Why  should  sickness,  pregnancy,  etc.,  be  considered  as 

predisposing  causes  of  caries? 

47.  Is  caries  hereditary,  and  if  not,  how  does  heredity  act 

as  a  predisposing  cause? 

48.  How   do   acid   saliva  and   mucus    act  as    predisposing 

causes? 

49.  Why  should  mal-position  of  the  teeth  act  as  a  predis- 

posing cause  of  caries? 

50.  How  does  the  wearing  of  partial  plates  act  as  a  predis- 

posing cause? 

51.  Why  should  lack  of  exercise  and  lack  of  cleanliness  act 

as  predisposing  causes? 

52.  What  is  the  effect  of  the  healthy  gum  septum  upon  the 

progress  of  caries  beneath  it? 

53.  What  is  the  effect  of  the  presence  of  pus  in  the  imme- 

diate neighborhood  of  caries? 

15 


54.  Name  the  four  stages  of  caries. 

55.  Define  what  is   meant   by  the   incipient  or   superficial 

stage. 

56.  Define  what  is  meant  by  the  Progressive  stage. 

57.  Define  what  is  meant  by  the  Deep-seated  stage. 

58.  Define  what  is  meant  by  the  Complicated  stage. 

59.  Into  what  four  classes  are  cavities  divided  as  to  their 

points  of  beginning? 

60.  Why  should  pits  and  grooves  in  the  enamel  favor  be- 

ginning of  caries? 

61.  What  proportion  of  all  cavities  occur  at  such  points? 

62.  Why   should    proximate    surfaces    favor    beginning    oi 

caries? 

63.  What  proportion  of  decays  occur  upon  proximate  sur- 

faces? 

64.  Why  should  they  outnumber  all  others  combined  3  1-3 

to  1? 

65.  Do  many  cases  of  caries   occur  upon   unclean   smooth 

surfaces?     Why  not? 

66.  With  what  is  decay  at  the  necks  of  the  teeth  nearly 

always  associated? 

67.  Is  this  class  more  prevalent  in  youth  or  old  age? 

68.  What  are  some  reasons  why  caries  decreases  with   ad 

vancing  age? 

69.  Is  caries  infectious? 

70.  What  bearing  does  this  fact  have  upon  the  importance 

of  prompt  and  thorough  treatment  of  dental  caries? 

71.  Are  teeth  of  the  same  class  on  opposite  sides  of  the 

mouth  equally  liable  to  caries  at  the  same  i>oints? 

72.  Why? 

73.  Give   two   reasons   for   the   occasional   spontaneous   ces- 

sation of  caries? 

16 


74.  Is   caries  most  prevalent  among  meat-eating  or  vege- 

table-eating nations? 

75.  Is  caries  of  the  teeth  found  in  the  lower  animals? 


TREATMENT    OF    CARIES..     EXAMINATION    OF    TEETH. 
HAND  RESTS  AND  GUARDS,  ETC. 

1.  Having  established   the  fact  that  dental   caries  is   ex- 

cited by  lactic  acid,  which  is  a  by-product  of  micro- 
organisms, what  three  methods  of  prophylaxis  or  pre- 
ventative treatment  are  suggested? 

2.  How   does   thorough   cleanliness   act   as   a   prophylactic 

treatment? 

3.  Is  it  competent  for  the  dentist  to  instruct  his  patients 

how  properly  to  cleanse  their  teeth? 

4.  What  are  some  of  the  suggestions  you  would  make  to 

patients  as  to  means  and  methods  of  cleansing  the 
mouth  and  teeth? 

5.  Why  is  neutralization  indicated  as  a  prophylactic  treat- 

ment? 

6.  Name  some  agents  you  would  employ  for  neutralization 

and  tell  how  and  when  they  should  be  used. 

7.  For  what  specific  purpose  would  you  employ  antisepsis? 

8.  Name  several  good  antiseptics. 

9.  To  what  extreme  dilution  is  HgCla  still  effective  in  pre- 

venting  the   growth   of   micro-organisms? 

10.  How    much  stronger  is    HgClo  than    carbolic    acid,  or 

rather,  how  much  more  effective  as  a  germicide  is 
HgClz  than  carbolic  acid  of  same  dilution? 

11.  What  is  the  strongest  solution  of  HgClj,  that  is  safe  to 

use  on  the  hard  tissues  of  tooth? 

12.  What  is  the  objection  to  the  use  of  bichloride  of  mer- 

cury as  a  mouth  wash? 

XI 


13.  To   what   extreme   dilution   is   AgNo..   still   effective   in 

preventing  the  growth  of  micro-organisms? 

14.  What  is  the  objection  to  the  use  of  AgNOg  for  this  pur- 

pose in  the  mouth? 

15.  Name  an  antiseptic  which  would  be  effective  and  un- 

objectionable and  give  formula  in  which  it  could  be 
'       employed  as  a  mouth  wash.* 

16.  Do     the    filling     materials     usually    employed     possess 

marked  antiseptic  properties? 

17.  What  filling  materials  do  possess  antiseptic  properties? 

18.  What  is  the  action  of  tobacco  on  the  germs  of  caries? 

19.  Name  the  three  therapeutic  treatments  for  dental  caries. 

20.  What  drug  is  the  most  effective  to  employ  in  medica- 

tion  as   a  therapeutic   treatment? 

21.  In  what  stage  of  caries  may  excision  be  employed  as  a 

therapeutic  measure? 

22.  Describe  methods  of  excision. 

23.  Upon  what  principle  is  filling  the  cavity  of  decay  in  a 

tooth  employed  as  a  treatment  for  caries? 

24.  Define  the  stopping  process.*  ^ 

25.  What  are  the  two  divisions  of  the  stopping  process? 

26.  What  is  included  in  the  surgical  part? 

27.  What  is  included  in  the  mechanical  part? 

28.  Would  you  call  the  stopping  process  a  reparative  or  a 

curative  treatment? 

29.  How  would  you  proceed  to  make  an  examination  of  a 

mouth    for  the  purpose    of  detecting    and    locating 
caries  of  teeth? 

30.  What  appearance  would  lead  you  to  suspect  presence  of 

caries  in  pits  and  grooves  of  teeth? 

31.  What   appearances    would   indicate   caries   upon   proxi- 

mate surfaces  in  close  contact? 

18 


S2.    How  would  you  proceed  to  examine  proximate  surfaces? 

33.  Wliat  precaution  should  be  adopted  to  protect  patient 

from  injury  from  slipping  of  instrument? 

34.  I>escribe   several   methods  of   securing  hand   rests   and 

guards. 

35.  Name  the  several  grasps  employed  in  properly  holding 

instruments.     Illustrate  them. 

36.  To    be    a   skillful    operator    requires    what    collateral 

knowledge  and  training?* 

37.  Describe  the  correct  posture  of  the  body  of  the  opera- 

tor at  the  chair  to  permit  most  effective  effort. 

38.  Make  some  suggestions  as  to  the  hygiene  of  the  opera- 

tor at  the  chair. 

39.  How  may  the  proper  use  of  the  mouth  mirror  contrib- 

ute to  the  comfort  and  hygiene  of  the  operator? 

40.  Make  some  suggestions  as  to  the  proper  bearing  of  the 

operator  towards  his  patient. 

41.  Why  is  it  important  to  cleanse  the  teeth  of  all  foreign 

deposits   before   undertaking  other   operations   upon 
them? 

42.  Give  details  of  procedure  in  cleaning  teeth. 

43.  What  is  the  technical  name  of  instruments  used  to  re- 

move deposits  of  salivary  calculus? 

44.  What   materials   are   employed   to   remove  stains  from 

the  teeth? 

45.  Why   is     it   important    to    thoroughly   sterilize    instru- 

ments? 
4f>.    What  classes  of  instruments  demand  the  most  careful 
sterilization? 

47.  What  is  the  most  effective  method  for  the  sterilization 

of  steel  instruments? 

48.  How  would  you  sterilize  instruments  that  might  be  in- 

jured by  boiling? 

19 


49.  What  would  be  your  advice  as  to  the  care  of  mouth 

mirrors? 

50.  Make    some    suggestions    as   to   details   of    cleanliness 

about  the  operating   chair,   the  operating  table   and 
cabinet. 


INSTRUMENT    NOMENCLATURE. 

1.  What  are  the  three  divisions  or  parts  of  a  cutting  in- 

strument or  excavator? 

2.  Define  each  part. 

3.  What  is  meant  by  an  order  name  of  an  instrument? 

4.  Give  examples  of  order  names. 

5.  What  is  meant  by  a  sub-order  name? 

6.  Give  example. 

7.  What  is  meant  by  a  class  name?    What  part  of  the  in- 

strument does  it  describe? 

8.  Give  examples. 

9.  What  is  meant  by  a  sub-class  name? 

10.  Give  examples. 

11.  What  is  meant  by  rights  and  lefts? 

12.  What  are  the  two  varieties  of  rights  and  lefts? 

13.  What  is  a  hatchet  excavator? 

14.  What  is  a  hoe  excavator? 

15.  What  is  a  spoon  excavator? 

16.  Are  spoons  always  rights  and  lefts? 

17.  What  is  a  discoid  excavator? 

18.  What  is  a  cleoid  excavator? 

19.  What  are  chisel  excavators? 

20.  What  is  meant  by  the  term  "monangle  excavator"? 

21.  What  is  a  contra-angle? 

22.  What  is  the  object  to  be  gained  by  contra-angling? 

20 


23.  Wliat  is  a  bin-angle-contra-angle? 

24.  What  is  a  triple-angle-contra-angle? 

25.  What  is  the  first  rule  for  contra-angling? 

26.  Give  a  test  for  proper  contra-angling  of  an  instrument. 

27.  Define  what  is  meant  by  a  "formula  name"  of  an  in- 

strument. 

28.  What  do  the  figures  of  a  formula  indicate,  and  in  what 

terms? 

29.  When  is  a  fourth  figure  used  in  the  formula? 

30.  Who  devised  the  system  of  formula  names  for  dental 

instruments  and  arranged  excavators  in  sets? 

31.  Which  of  the  excavators  are  known  as  "ordinaries"? 

32.  Which  are  known  as  "specials"? 

33.  Which  are  classed  as  "side  instruments"? 


CAVITY    NOMENCLATURE. 


1.  From  what  do  cavities  derive  their  names?     Give  ex- 

amples. 

2.  What  are  the  axial  surfaces  of  teeth? 

3.  Name  the  axial  surfaces  of  a  molar. 

4.  Define   a  "line  angle." 

5.  How  are  line  angles  on  a  tooth  surface  named?    Give 

example.  ^ 

6.  Define  a  "point  angle." 

7.  How  are  point  angles  named? 

8.  What  is  an  axial  cavity"? 

9.  From  what  do  walls  of  cavities  take  their  names? 

10.  What  is  the  fifth  cavity  wall  in  axial  cavities  called? 

11.  What  is  the  fifth  cavity  wall  in  occlusal  cavities  called? 

12.  What   is   the   "sub-pulpal   wall"? 

21 


13.  How  are  the  line  angles  within  a  cavity  named?  ^ 

14.  How  many  sets  of  line  angles  within  a  box-like  cavity? 

15.  How  many  point  angles  in  such  a  cavity? 

16.  Name  the  line  angles  in  a  buccal  cavity, 

17.  Name  the  point  angles  in  the  same  cavity. 

18.  What  is  a  ''complex  cavity"? 

19.  How  does  the  nomenclature  of  complex  cavities  differ 

from  that  of  simple  cavities? 

20.  How  may  surfaces  of  teeth  be  divided  for  convenience 

of  description? 

21.  What  is  included  in  the  enamel  margin  of  a  cavity? 

22.  Define  the  term,  "cavo-surface  line  angle." 

23.  What  is  the  "dento-enamel  junction"? 

24.  Name  the  three  planes  of  the  teeth  used  for  conven- 

ience of  description. 

25.  To  what  is  the  term  "embrasure"  applied? 


HYPER-SENSITIVE    DENTIN. 

1.  Is  live  dentin  sensitive  in  its  normal  state? 

2.  Through  what  anatomical  structure  of  the  dentin  is  sen- 

sation conveyed  from  its  periphery  to  the  surface  of 
the  pulp? 
8.     What  tissue  is  contained  within  the  tubuli  of  live  den- 
tin? 

4.  Has  it  been  positively  demonstrated  that  the  fibrillae  of 

the  dentin  are  composed  of  nerve  tissue? 

5.  What  causes   dentin   to  become  hyper-sensitive? 

6.  What   is    the    most   common   cause    of   hyper-sensitive 

dentin? 

7.  Name  some  other  causes. 

8.  Is   freshly   fractured   dentin   hyper-sensitive? 

22 


9.     At  what   point  in   dentin   is   found   the   most   sensitive 
zone,  and  why? 

10.  What  relation  exists  between  the  color  of  caries  and 

hyper-sensitive  dentin?    Explain  why  the  light  colors 
are  most  sensitive. 

11.  What  conditions  have  a  modifying  influence  on  hyper- 

sensitive dentin? 

12.  Explain  how  the  rapidity    of    progress    of    caries    may 

modify  hyper-sensitivity  of  dentin. 

13.  In  what  way  may  density  of  the  tooth  substance  influ- 

ence hyper-sensitive  dentin? 

14.  How  may  the  age  of  an  individual  influence  hyper-sen- 

sitivity of  dentin? 

15.  In  what  several  ways  may  the  state  of  health  of  the  in- 

dividual influence  the  degree  of  hyper-sensitivity  of 
dentin? 

16.  What  are  the  four  classes  of  treatment  for  hyper-sensi- 

tive dentin? 

17.  What  is  meant  by  a  "therapeutic"  treatment,  and  give 

examples? 

18.  Give  examples  of  chemical  treatment. 

19.  Explain  how   coagulants   act  in  reducing  sensitivity  of 

dentin? 

20.  Explain  the  principle  upon  which  warm  air  acts  as  a 

rejnedy. 

21.  Describe  method  of  application  of  warm  air  as  a  rem- 

edy. 

22.  Explain  the  action  of  caustic  potash  and  carbolic  acid 

when  used  as  a  remedy  and  what  precautions  should 
be  observed. 

23.  Explain  the  action  of  formaldehyde  when  used  in  com- 

bination as  a  remedy. 

23 


24.  Explain   the   action   of   chloride   of   zinc.     In   what  two 

ways  does  it  act  in  reducing  hyper-sensitivity  of  den- 
tin?    What  precautions  to  be  observed  in  its  use? 

25.  Explain  the  action  of  silver  nitrate  used  as  a  remedy 

and  state  objection  to  its  use. 

26.  Should  arsenic  ever  be  used  for  this  purpose? 

27.  Is  it  advisable  to  use  general  anaesthesia  in  excavating 

hyper-sensitive  dentin? 

28.  What  is  the  most  effective  way  of  producing  anesthe- 

sia of  dentin? 

29.  What  is  "cataphoresis"? 

30.  What  are  the  positive  and  negative  poles  called? 

31.  What  is  the  unit  of  strength  or  flow? 

32.  What  is  the  unit  of  pressure? 

33.  What  is  the  unit  of  resistance? 

34.  Why  is  resistance  between  battery  and  patient  neces- 

sary, and  how  is  it  controlled? 

35.  What  strength  of  cocaine  solution  should  be  employed? 

36.  Describe   in   detail    method   of   application   of   cataphor- 

esis. 

37.  What   are   some  of  the   objections   to  the   use  of   cata- 

phoresis? 

38.  Can  anaesthesia  of  the  dentin  be  produced  by  mechan- 

ical pressure  forcing  cocaine  in  solution  into  the  tu- 
bules? 

39.  Describe  some  ways  of  doing  this. 

40.  What  is   meant  by  the  "mechanical"   treatment  of  hy- 

per-sensitive dentin? 

41.  Which    acts   most   effectively    in    reducing   hyper-sensi- 

tivity of  dentin,  metallic  or  non-metallic  temporary 
fillings? 

24 


42.  What  takes  place  under  fillings  to  produce  a  favorable 

effect  upon  hyper-sensitive  dentin? 

43.  How    would  you    treat  mild    cases  of    hyper-sensitive 

dentin? 

44.  What  influence  does  temperament  have  upon  this  con- 

dition? 


PREPARATION  OF  CAVITIES. 

1.  Why  is  it  desirable  to  separate  teeth  previous  to  pre- 

paring iproximate  cavities?     The  two  objects  to   be 
gained? 

2.  What  are  the  three  classifications  of  methods  of  sep- 

aration according  to  speed? 

3.  By  what  means  is  immediate  separation  accomplished? 

4.  By  what  means  is  rapid  separation  accomplished? 

5.  By  what  means  is  slow  separation  accomplished? 

6.  What  is  the  objection  to  the  use  of  rubber  wedges? 

7.  What  procedure  is  frequently  necessary  after  using  a 

rubber  wedge? 

8.  What  is  the  objection  to  the  use  of  wooden  wedges? 

9.  When  is  it  permissible  to  use  the  file  for  separating 

teeth  ? 

10.  How  would  you  treat  superficial  decay? 

11.  What  procedures  are  included  in  preparation  of  cavi- 

ties ? 

12.  Name  the  six  classes  of  cavities  into  which  they  are 

divided  according  to  treatment  in  preparation.* 

13.  What  are  the  two  great  divisions  into  which  all  cavi- 

ties are  classed?* 

14.  Which  of  the  six  classes  of  cavities  belong  to  the  great 

class  of  smooth  surface  cavities? 

25 


15.  in  what  locations  do  we  find  cavities  of  the  first  class? 

16.  By  what  means  may  the  operation  of  preparing  cavities 

be  expedited,  avoiding  confusion   and  haste? 

17.  What  are   the  four  steps  in  cavity  preparation?*  ' 

18.  What  is  meant  by  '"gaining  access"? 

19.  What  is  meant  by  "retention  form"? 

20.  What  is  meant  by  "resistance  form"? 

21.  What  is  included  in   the  management  of  enamel   mar- 

gins? 

22.  In  the  rules  for  preparation  of  enamel  margins  what  is 

Rule  1  for  extension  of  margins?* 

23.  Is  there  any  exception  to  this  rule? 

24.  What  is  Rule    2  referring  to  further  extension? 

25.  What  is  Rule  3  referring  to  "self  cleansing"  margins? 

26.  What  is  Rule  4  referring  to  relation  of  cavity  margin  to 

a  developmental  groove? 

27.  What  is  Rule  5  referring  to  extension  to  include  devel- 

opmental  grooves,  etc.? 

28.  What  is  Rule  6  referring  to  outlines  of  margins? 

29.  What  is  Rule  7  referring  to  relations  of  labial,  buccal, 

and  lingual  margins  to  each  other  and  to  the  seat? 

30.  What  is  Rule  8  as  to  final  management  of  margins? 

31.  What  is  included  in  "cavity  toilet"? 

32.  What  is  meant  by  the  term  "crushing  strain"?* 

33.  What  constitutes  the  "seat"  in  a  cavity?* 

34.  What  is  meant  by   the   term  "step"   in   cavity  prepara- 

tion?* 

35.  What  is  the  rule  for  arrangement  of  "seat"  and  "step"?* 

36.  What  is  meant  by  the  term  "extension  for  prevention"?* 

37.  What  is  meant  by  the  term  "affected  dentin"?* 

38.  What  is  meant  by  the  term  "infected  dentin"?* 

26 


39.  What  are  the  four  varieties  of  carious  matter  found  in 

cavities  in  teeth?* 

40.  What  is  a  simple  cavity? 

41.  What  is  a  complex  cavity? 

42.  What  instruments  would  you  use  and  how  would  you 

proceed  to  gain  access  to  a  cavity  of  the  first  class? 

43.  What  physical  arrangement  of  what  anatomical  struc- 

ture of  the  tooth  do  you  take  advantage  of  in  gain- 
ing access  to  a  cavity  of  the  first  class? 

44.  What   instruments   would   you   employ   and   how   would 

you  proceed  in  the  second  step  in  the  preparation 
of  cavities  of  the  first  class? 

45.  How  do  you  obtain  retention  form  in  cavities  of  class 

1? 

46.  What  are   the  two  rules  for  obtaining  retention  form 

in  cavities  of  class  1?* 

47.  How    is   resistance  form    given   to    a  simple    occlusal 

cavity? 

48.  Why  is  resistance  form  necessary  in  such  a  cavity? 

49.  What  instruments   would   you   employ   and   how   would 

you  form  the  enantel  margins  in  this  class  of  cavi- 
ties? 

50.  Why  would  you  bevel  the  margins? 

51.  Is    extension    for    prevention    necessary    in   cavities   of 

class  1? 

52.  In  cases  of  deep-seated  caries  how  much  of  the  carious 

matter  should  be  removed? 

53.  What  medication  would  be  advisable  after  excavating 

deep-seated  caries  and  for  what  purpose? 

54.  What  instruments  would  you  use  and  how  would  you 

proceed  to  prepare  a  cavity  of  the  second  class? 

27 


55.  Where  is  the  most  frequent  location  of  cavities  of  the 

second  class? 

56.  What  retention  form  is  required  in  cavities  of  the  sec- 

ond  class  and  how  obtained? 

57.  Is  resistance  form  needed  in  such  cavities? 

58.  Is  extension  for  prevention  necessary? 

59.  What  would  be  your  management  of  enamel  margins  in 

cavities  of  class  two? 

60.  What  is  meant  by  '"convenience  form"?* 

61.  Under  what  circumstances  and  for  what  purpose  is  con- 

venience form   required  in   cavities  of  the  first  and 
second  classes  and  how  obtained? 

62.  In  the  preparation  of  cavities  of  the  third  class  what 

is    the   first   procedure   and   why   necessary   in   most 
cases? 

63.  By  what  means  may  separation  of  incisors  be  accom- 

plished? 

64.  Where  both  labial  and  lingual  walls  are  intact  in  cases 

of  cavities  of  the  third  class  in  upper  incisors  how 
would  you  proceed  to  open  into  such  cavities? 

65.  Is  the  preservation  of  the  labial  wall  in  certain  cases 

warranted  as  a  prophylactic  measure  or  for  esthetic 
reasons  only? 

66.  What  instrument  would  you  use  to  gain  Access  to  such 

a  cavity  and  describe  grasp  and  guard  you  would  em- 
ploy? 

67.  With  what  instruments  and  how  would  you  proceed  with 

the  second  step  in  the  preparation  of  a  cavity  of  the 
third  class? 

68.  What  provision  would  you  make  for  retention  form  in 

such  a  cavity,  where  would  you  locate  such  provisions 
and  with  what  instruments  would  you  make  them? 
28 


69.  Where  should  the  gingival  wall  be  placed? 

70.  If  a  groove  is  made  in  the  gingival  wall  at  what  point 

relative  to  the  dento-enamel  junction  should  it  be 
located? 

71.  What  is  the  preferable  form  of  the  gingival  wall  labio- 

lingually  and  from  the  axial  wall  to  the  cavo-surface 
angle? 

72.  In  cases  of  normal  occlusion  how  is  provision  made  for 

resistance  form  in  cavities  of  class  three? 

73.  At  what  points  in  cavities  of  the  third  class  is  extension 

for  prevention  necessary? 

74.  What  should  be  the  form  of  the  axial  wall,  how  modified 

in  case  of  probable  near  approach  to  pulp  and  how 
placed  relative  to  the  labial  and  lingual  enamel  walls? 

75.  What  would  be  your  management  of  the  enamel  margins 

in  this  cavity;  what  instruments  would  you  use?  If 
a  chisel  is  employed  in  what  direction  on  the  margins 
should  it  be  used? 

76.  What  modification  in  the  preparation  of  cavities  of  the 

third  class  is  called  for  in  the  lower  incisors? 

77.  When  the  preparation  of  cavities  in  these  cases  exposes 

the  gold  upon  the  labial  surfaces  only  slightly  what 
further  extension  is  called  for  and  for  what  purpose? 

78.  In    cavities    of   the    fourth    class    what    modification    is 

called  for  in  the  preparation  at  the  gingival  wall? 

79.  In  removing  a  frail  incisal  angle,   mesial  or  distal,   to 

what  line  on  labial  surface  should  it  be  cut?  What 
instrument  is  used? 

80.  What   should   be    the   outline   of   the    margin    or   labial 

surface  when  completed? 

81.  How   is  resistance  form   obtained    in    such    a   cavity? 

Describe  procedure  and  instruments  used. 

29 


82.  How  does  preparation  of  the  step  differ  in  a  tooth  with 

thin  cutting  edge  and  one  with  thick  cutting  edge? 

83.  What  would   be  the   procedure   in   preparation   of   step 

in  case  of  incisor  with  abraded  incisal  edge? 

84.  How  do  cavities  of  the  fifth  class  rank  with  other  classes 

as  to  difficulty  of  proper  preparation? 

85.  Describe  procedure  and  instrumentation  in  opening  into 

a  cavity  in  the  mesial  surface  of  a  lower  first  molar. 

86.  What  margins  should  be  extended  and  how  far,  in  putting 

into  practice  the  principles  of  extension  for  preven- 
tion? 

87.  What  is  a  good  rule  for  determining  how  far  into  em- 

brasures   the    labial   and    lingual   walls    should    be 
extended  for  prevention?* 

88.  What  provision  should  be  made  in  the  gingival  wall  for 

retention  form  and  how  is  it  accomplished? 

89.  If  convenience  points  for  starting  a  gold  filling  are  re- 

quired in   the  gingival   wall,  where  should   they   be 
located  and  how  formed? 

90.  Should  the  buccal  and  lingual  walls  be  undercut?    If  so, 

how  is  it  done  and  at  what  point? 

91.  How  is  resistance  form  obtained  in  this  cavity? 

92.  Describe  instrumentation  in  preparing  the  step? 

93.  What   relation    should    the    fioor   of   the    step   and    the 

gingival   wall   bear   towards   each  other  and   to   the 
direction  of  stress  of  mastication? 

94.  What   should  be  the  form  of  the  gingival  wall  bucco- 

lingually  and  from  the  axial  wall  to  the  cavo-surface 
angle? 

95.  What  would  be  your  management  of  the  enamel  margins 

in  this  cavity? 

96.  What  instruments  are  used  to  bevel  the  gingival  margin? 

30 


97.  In  large  mesio-occluso-distal  cavities  in  bicuspids,  what 

precaution   should   be   practiced   in  reference   to   the 
lingual  cusp? 

98.  Where,  in  such  a  case,  the  tooth  is  pulpless,  what  would 

be  good  practice  in  reference  to  both  cusps? 

99.  At  what  stage  in  the  preparation  of  cavities  is  it  advis- 

able to  put  on  the  rubber  dam? 

100.  What  are  the  objects  to  be  attained  by  the  use  of  the 

rubber   dam? 

101.  What  preliminary  steps  should  be  taken  preparatory  to 

the  placing  of  the  rubber  dam? 

102.  How  are  holes  properly  made  in  the  rubber  dam  and 

what  is  the  rule  as  to  spacing  of  holes? 

103.  Name  the  two  sides  of  the  rubber  dam  as  suggested  by 

their  position  when  placed  on  the  teeth? 

104.  How  many  teeth  should  be  included  and  how  would  you 

proceed  to  adjust  the  dam  in  case  of  cavities  upon  the 
mesial  surfaces  of  the  upper  central  incisors? 

105.  How  is  the  dam  retained  in  position  about  the  necks 

of  the  incisors  and  what  auxiliary  appliances  are  used 
to  hold  it  in  proper  position? 

106.  How  would  you  proceed  to  adjust  the  dam  for  filling 

a  cavity  in  the  mesial  surface  of  an  upper  first  molar? 
How  many  and  what  teeth  should  be  included? 

107.  How  is  the  dam  retained  upon  a  molar? 

108.  What  precautions  should  be  used  in  removing  the  rubber 

dam? 

109.  What  means,  other  than  the  rubber  dam,  may  be  em- 

ployed for  maintaining  dryness  in  minor  operations? 
Give  details  of  application. 

110.  How  would  you  prepare  a  cavity  of  the  sixth  class  oc- 

curring upon  incisal  edge  of  an  incisor?     What  in- 
struments would  you  use? 

31 


111.  When  is  it  advisable  to  employ  retaining  screws  in  this 

class  of  cavities? 

112.  What  special  preparation  is  called  for  in  cavities  for 

procelain  or  gold  inlays? 

113.  What  is  the  difference  in  preparation  of  enamel  margins 

for  porcelain  and  a  gold  inlay? 

114.  How  does  the  preparation  of  a  cavity  to  receive  an  amal- 

gam filling  differ  from  that  for  a  gold  filling?    Differ- 
ence as  to  margins  and  why? 

115.  What  medication   should  be   applied   to    the    walls    of 

caviities  after  completion  of  preparation,  where  the 
dentin  has  been  hyper-sensitive  and  for  what  purpose? 

116.  What  other  medication  is  sometimes  advisable  and  for 

what  purpose? 


FILLING    MATERIALS   AND    FILLING. 

1.  What  are  the  four  general  objects  in  view  in  filling  cari- 

ous teeth?* 

2.  What  points  must  be  taken  into   consideration   in  the 

selection  of  filling  materials  for  special  cases?* 

3.  Upon   what   two    things    does    success   in   filling   teeth 

deipend? 

4.  What    are    the    three    essential    qualities    of    a    filling 

material? 

5.  Name  three   other   desirable   qualities   of   a   filling  ma- 

terial. 

6.  What   properties   should    a   filling   material   possess  to 

make  it,  in  your  opinion,  the  ideal  or  perfect  filling 
material? 

7.  Name  the  filling  materials  in  use. 

8.  Which  of  these  holds  the  first  place  in  value? 

32 


9.     WTiich  may  be  said  to  hold  second  place? 

10.  Which  may  be  classed  as  permanent? 

11.  In   what   four   ways   may   fillings   be    said    to   preserve 

teeth?* 

12.  What  are  the  properties  of  gold  that  make  it  valuable 

as  a  filling  material? 

13.  What  are  its  chief  disqualifications? 

14.  Under  what  conditions  is  the  color  of  gold  least  objec- 

tionable   when    exposed  in  the  anterior  part    of    the 
mouth?* 

15.  How  long  has  gold  been  in  use  as  a  material  for  filling 

teeth  ? 

16.  What  is  meant  by  cohesive  gold? 

17.  What  is  meant  by  non-cohesive  gold? 

18.  Which  is  the  natural  property  of  chemically  pure  gold? 

19.  When  and  by  whom  was  the  cohesive  property  of  gold 

discovered  and  first  made  use  of?* 

20.  By   what  methods  is   gold  purified? 

21.  Is  the  gold  bullion  of  the  mints  fine  enough  for  dental 

foils? 

22.  What  fineness  in  the  1,000  parts  is  attained  by  some  foil 

manufacturers? 

23.  How  is  foil  made? 

24.  What  characer  of  impurity  is  employed  to  render  pure 

gold    non-cohesive    and    what    property    of    the    gold 
makes  the  employment  of  such  agents  possible? 

25.  What  gas  is  usually  occluded  upon   surface  of  gold   to 

render  it  non-cohesive? 
20.     Do  other  metals  possess  the  property  of  cohesion? 
27.     What  effect  does  annealing  have  upon  non-cohesive  gold, 

and  why? 
23.     What  amount  of  heat  is  best? 

33 


29.  Is  it  always  essential  that  gold  foil  should  be  heated 

to  redness  to  render  it  cohesive? 

30.  "What  precautions  should  be  observed  in  annealing  gold? 

31.  Describe    some   methods   of   annealing   gold. 

32.  In  what  two  ways  may  annealing  of  non-cohesive  gold 

render  it  cohesive?* 

33.  What  treatment  of  the   surface  of  pure  gold  foil   will 

render   it   permanently   non-cohesive   even   when   an- 
nealed?* 

34.  What  two  groups  of  chemical  compounds  are  especially 

injurious   to   gold  foil?* 

35.  What  is  a  common  source  of  these  gases?* 

36.  What  chemical  is  it  advisable  to  keep  in  the   drawer 

with   your   gold   foil?* 

37.  In  what  manner  does  this  chemical  protect  the  surface 

of  gold  foil  from   contamination? 

38.  What  is  crystal  gold  and  how  is  it  made? 

39.  Name  some  forms  in  which  gold   foil  is  prepared  for 

filling  teeth. 

40.  What  forms  of  preparation  are  employed  when  used  as 

non-cohesive  gold? 

41.  Describe   method   of   making   foil  into   cylinders. 

42.  Upon  what  does  the  retention  of  gold  in  a  cavity  de- 

pend?* 

43.  Name  the  three  methods  of  packing  gold  into  a  cavity 

in   a  tooth.* 

44.  Which  form  or  forms  of  gold,  cohesive  or  non-cohesive, 

is  employed  in  each  method? 

45.  What  are  the  resistances  to  be  overcome  in  packing  gold 

requiring   the   employment  of  force?* 

46.  Name   the    four    forms    of   applied    force    employed    in 

packing  gold,* 

34 


47.  Describe  what  is  meant  by  "direct  pressure,"  and  when 

is  it  employed? 

48.  What   is   meant   by   "wedging,"   and    when    is    it    em- 

ployed? 

49.  What  is  meant  by  "leverage,"  and  when  and  how  is  it 

employed? 

50.  What   is   "percussion,"   and   by   what   means   is    it   em- 

ployed? 

51.  Which   forces    are    the    most   powerful,   and   what    pre- 

caution  should   be   taken   in   their  employment? 

52.  Name  several  forms  of  mallets  used  in  packing  gold  by 

percussion? 

53.  What  three  objects  are  to  be  borne  in  mind  in  packing 

gold  into  a  cavity?* 

54.  Why  is  it  important  that  the  adaptation  of  gold  should 

be  perfect  throughout  the  walls  of  cavity  as  well  as 
at  the  margins? 

55.  What  bearing  does  the  form  of  the  external  surface  (as 

to   restoration   of  contour)    of   the  filling  have   upon 
its  ultimate  success? 

56.  Is  it  essential  that  the  greatest  possible  density  of  the 

mass  of  gold  in  a  filling  should  be  attained   to? 

57.  What  risk  is  incurred  in  complete  condensation  of  the 

gold   in  frail   teeth? 

58.  At  what  part  of  a  filling  is  great  density  desirable? 

59.  What  effect  does  density  have  upon  thermal  conductiv- 

ity? 

60.  What  kind  of  plugger  points  are  employed  in  packing 

cohesive  gold? 

61.  What  kind  are  used  in  packing  non-cohesive  gold? 

62.  What  are  foot-pluggers,  and  when  are  they  employed? 

35 


63.  What  relation  does  the  size  or  area  of  the  plugger  point 

bear  to  the  impacting  power  under  a  given  amount  of 
force?* 

64.  Describe  the  process  of  filling  a  simple  cavity  in  the 

occlusal  surface  of  a  molar  with  cohesive  gold. 

65.  In  packing  cohesive  gold  against  a  wall   of  cavity,  in 

what    direction    with    reference    to    the    wall    should 
force  be  applied,  and  why? 

66.  What  are  the  essential  points  to  be  observed  in  making 

a  filling  with  cohesive  gold? 

67.  What  is  the  principle  involved  in  packing  non-cohesive 

gold  into  a  cavity? 

68.  In  what  form  should  non-cohesive  gold  be  prepared  for 

most  efiicient  employment  of  the  principle  involved? 

69.  Describe  the  process  of  filling  a  simple  occlusal  cavity 

with  non-cohesive  gold. 

70.  In  what  classes  of  cavities  may  both  cohesive  and  non- 

cohesive  gold  be  advantageously  used,  and  which 
portions  of  each  cavity  should  be  filled  with  which 
kind   of   gold? 

71.  What  effect  does  burnishing  have  upon  a  non-cohesive 

gold  filling,  and  at  what  stage  of  the  operation 
should  it  be  used? 

72.  What  effect  does  burnishing  have  upon  a  cohesive  gold 

filling? 

73.  What    precaution    should    be   observed    in    the    use    of 

burnishers  ? 

74.  How   full    should   a   cavity   be   packed   with   gold,   and 

why? 

75.  What  importance  attaches  to  proper  finishing  of  fillings? 

76.  Describe   method   of   finishing   an   occlusal   filling   in   a 

molar. 

36 


77.  Describe  method  of  finishing  a  filling  upon  a  proximate 

surface  of  an  upper  incisor. 

78.  What  is  the  most  vulnerable  point  to  secondary  decay 

in  proximate  fillings,  and  why? 

79.  When  was  tin  first  used  as  a  filling  material? 

SO.     What  properties  of  tin  render  it  valuable  as  a  filling 
material? 

81.  Has  tin  any  cohesive  property? 

82.  Has   it  any   antiseptic  action  on   tooth   substance? 

83.  What  action  do  oxygen  and  sulphureted  hydrogen  have 

on  tin? 

84.  How  is  tin  prepared  for  use  as  a  filling  material? 

85.  Does  it  have  any  tendency  to  discolor  a  tooth? 

86.  Describe  method  of  making  a  filling  of  tin  in  a  simple 

cavity. 

87.  How  may  it  be  combined  with  gold? 

88.  What  effect  does  the  gold  seem  to  have  upon  tin  when 

used   in   combination? 

89.  What  is  an   amalgam? 

90.  Is  an  amalgam  a  sub-chemical  compound  or  a  mechanical 

mixture? 

91.  When  was  amalgam  first  used  as  a  filling  material?* 

92.  By  whom  was  it  introduced  into  this  country  and  under 

what  name?* 

93.  What   kind   of   reception   was    amalgam   given   by   the 

profession   upon   its   introduction   into   this   country? 

94.  What  properties   of  amalgam   render  it  valuable   as   a 

filling  material? 

95.  What  are  some  of  the  obections  to  the  use  of  amalgam? 

96.  In  what  class  of  cases  should  it  be  used? 

97.  Name   the    five   physical    properties   peculiar   to   amal- 

gams.* 

37 


98.  What  causes  amalgams  to  harden  or  set? 

99.  How   is  the   degree  of  expansion  or  contraction  of  an 

amalgam  measured? 

100.  The  extent  of  expansion  or  contraction  of  amalgams  is 

due  to  or  influenced  by  what  factors?* 

101.  How  is  the  so-called  tendency  in  amalgams  to  "spheroid" 

explained? 

102.  What  is  meant  by  the  "flow"  of  amalgams  under  press- 

ure?* 

103.  Do  all  metals  have  tendency  to  flow  under  pressure? 

104.  How    does    the   flow    of   amalgam    differ    from    that   of 

metals? 

105.  What  is  meant  by  the  term  "edge  strength"  as  applied 

to  amalgams? 

106.  What  is  the  purpose  of  annealing  or  ageing  alloys  for 

amalgams?* 

107.  How  is  annealing  accomplished?* 

108.  What  effect  does  annealing  of  alloys  have  upon  expan- 

sion,   contraction,    flow,    edge    strength,    amount     of 
mercury  used,  and  time  of  setting  of  amalgams?* 

109.  In  a  silver-^tin  alloy  what  propottions  of  these  metals 

give  the  most  stable  amalgam,  as  to  expansion  and 
contraction,    when   unannealed? 
no.     What   change  in   the   formula  of  silver-tin   alloy  would 
be  required  when  annealed,  to  give  stability  to  the 
amalgam? 

111.  Explain  the  philosophy  of  such  change  in  formula  being 

required. 

112.  In  what  way  are  the  physical  properties  of  the  silver- 

tin-alloy   amalgams  modified   by   the  addition   to   the 
formula  of  5  per  cent  of  gold?* 

38 


113.  How  does  the  addition  of  5  per  cent  of  platinum  modify 

the   silver-tin  alloy  when  amalgamated? 

114.  How  does  the  addition  of  5  per  cent  of  copper  affect 

such  an  amalgam? 

115.  What  is  the  effect  of  zinc  5  per  cent  when  combined 

with  the  silver-tin  alloy? 

116.  Give  formula  for  an  alloy  affording  best  results  as  an 

amalgam,  composed  of  silver,  tin,  gold  and  zinc* 

117.  Give  formula  composed  of  silver,  tin,  copper  and  zinc 

affording  best  amalgam. 

118.  What  do  the  terms  "binary,"   "ternary,"   and  "quarter- 

nary"  mean  as  applied  to  amalgams? 

119.  To  which  of  these  does  copper  amalgam  belong? 

120.  What  properties  of  copper  amalgam  render  it  valuable 

as  a  filling  material? 

121.  What  are  the  objections  to  the  use  of  copper  amalgam? 

122.  Describe  method  of  manipulating  copper  amalgam. 

123.  Describe  method  of  mixing  ordinary  amalgam. 

124.  Describe  methods  of  mixing  quick-setting  amalgams. 

125.  What  kind  of  instruments  are  used  for  packing  amal- 

gam? 

126.  Describe  method  of  making  a  simple  filling  with  amal- 

gam. 

127.  What  amount  of  pressure  is  necessary  in  packing  amal- 

gam? 

128.  When  should  a  matrix  be  employed? 

129.  Describe  some  form  of  matrix  and  method  of  applica- 

tion. 

130.  Describe  the  finishing  of  an  amalgam  filling. 

131.  How  may  amalgam  be  combined  with  gold,  and  to  what 

is  due  the  favorable  effect  of  such  combination? 

132.  What  is  oxy-phosphate  of  zinc? 

39 


123.     Describe  method  of  mixing  and  introduction  into  cavity. 

134.  Is  dryness  essential  in  making  a  filling  of  this  material? 

135.  Under  what  circumstances  is  it  advisable  to  use  zinc 

phosphate? 

136.  What  are  the  defects  in  it  as  a  filling  material? 

137.  How  may  a  zinc  phosphate  filling  be  temporarily  pro- 

tected from  the  action  of  saliva  while  hardening? 

138.  How  may  amalgam  and  oxy-phospate  of  zinc  be  com- 

bined as  a  filling  material? 

139.  What  advantages  are  claimed  for  such  combination? 

140.  What  is   oxy-phosphate  of  copper? 

141.  What  is  the  color  of  oxy-phosphate  of  copper? 

142.  To  what  class  of  cases  should  it  be  limited  in  its  use? 

143.  Describe  method  of  mixing  oxy-phosphate  of  copper. 

144.  How    may   the   setting   of   oxy-phosphate   of   copper   be 

hastened? 

145.  For    what    purpose    is    oxy-sulf)hate    of    zinc     used     in 

dentistry? 

146.  What  is  oxy-chloride  of  zinc? 

147.  Describe  method  of  mixing  and  introduction  into  cavity. 

148.  What  are   the   obections   to  the  use  of  oxy-chloride  of 

zinc  as  a  filling  material? 

149.  For  what  purposes  is  it  particularly  useful  in  dentistry? 

150.  To  what  properties  of  gutta  percha  is  due  its  value  as  a 

filling  material? 

151.  Describe  method  of  making  a  filling  of  gutta  percha. 

152.  For   what   special    purpose    is   gutta   percha   useful   in 

operative  dentistry? 

153.  What  objectionable  change  takes  place  in  gutta  percha 

fillings? 

154.  What  is  the  essential  difference  between  an  inlay  and  a 

filling? 

40 


155.  In   what   classes   of  cavities   are   porcelain   inlays   indi- 

cated? 

156.  What  is  meant  by  the  term  "low  fusing"  as  applied  to 

procelain? 

157.  What  is  meant  by  the  term  "high  fusing"? 

158.  Describe  method  of  making  a  porcelain  inlay  matrix  by 

means  of  an  impression  of  the  cavity. 

159.  Describe  method  without  impression. 

160.  Under   what    circumstances    should    the    matrix    be   in- 

vested? 

161.  Describe  method  of  mixing  the  porcelain  body,   filling 

matrix  and  baking  or  fusing. 

162.  To  what  degree  of  fusion  should  the  first  bakings  be 

carried? 

163.  In  case  of  approximal  cavities  in  incisors  should  the 

shade  of  the  porcelain  be  slightly  darker  or  lighter 
than  the  natural  tooth? 

164.  Which   would   give   the   best   results   in   case  of  labial 

cavities? 

165.  What  treatment  should  be  given  the  porcelain  surface 

next  to  the  cavity  to  aid  in  its  retention? 

166.  Describe  the  setting  of  a  porcelain  inlay. 

167.  Describe  the  finishing  of  a  porcelain  inlay. 

168.  What  is  the  axiom  with  reference  to  porcelain  edges 

exposed  to  stress? 

169.  In  what  classes  of  cavities  are  gold  inlays  indicated? 

170.  What  carat  and  gauge  of  gold  should  be  used  in  making 

the  matrix  for  a  gold  inlay? 

171.  Describe  method  of  making  a  solid  gold  inlay. 

172.  By  what  means  is  large  restoration  of  contour  accom- 

plished? 

41 


173.  Describe  method  of  making  the  hollow  gold  inlay.* 

174.  What  advantages  attach  to  the  hollow  gold  inlay? 

175.  In  what  class  of  cases  is  it  an  advantage  to  take  an  im- 

pression of  the  cavity  and  secure  a  model? 

176.  Describe  procedures  in  setting  a  gold  inlay. 

177.  Describe  the  finishing  of  a  gold  inlay. 


DENTAL   PATHOLOGY  AND  THERAPEUTICS. 
DISEASES    OF   THE    PULP. 

Note:  The  lectures  under  this  heading  follow  closely 
the  text  in  Burchard's  Dental  Pathology  and  Therapeutics,  to 
which  work  the  student  is  directed  for  further  reading  and 
study.  The  subjects  are  similarly  treated  in  Marshall's 
Operative  Dentistry  with  some  variations  in  terminology.  No 
answers  to  these  questions  are  given  in  the  appendix,  with 
one  exception. 

1.  What  are  the  two  general  divisions  of  diseases  of  the 

pulp? 

2.  What  are  the  two  divisions  as  to  anatomical  features? 

3.  What  are  the  two  divisions  as  to  their  character? 

4.  What  are  "constructive  diseases"  of  the  pulp? 

5.  What  are  "destructive  diseases"   of  the  pulp? 

6.  What   is   the   essential   difference   between    these    two 

classes  of  diseases? 

7.  Name  the  forms  of  constructive  diseases  of  the  pulp. 

8.  Define  "tubular  dentinification." 

9.  Name  some  causes  of  tubular  dentinification. 

10.  What  alteration  in  appearance  takes  place  in  the  dentin 

due   to   tubular   dentinification? 

11.  What  is  meant  by  secondary  dentin? 

42 


12.  Where   is   secondary   dentin   deposited? 

13.  What  are  pulp  nodules? 

14.  What  conditions  within  the  pulp  favor  the  formation  of 

pulp  nodules? 

15.  How  do  they  differ  from  dentin  in  structure? 

16.  What  are  the  diagnostic  symptoms  of  pulp  nodules? 

17.  ^\Tiat  is  the  prognosis  as  to  the  life  of  the  pulp  when 

nodules  are  present? 

18.  Give  treatment  for  conditions  of  pulp  nodules. 

19.  What  is  calcific  degeneration  of  the  pulp? 

20.  What  does  calcific  degeneration  of  the  pulp  indicate? 

21.  Has  the  pulp  tactile  sense? 

22.  What  is  the  tactile  organ  of  a  tooth? 

23.  What  test  is  the  pulp  responsive  to? 

24.  What   is   meant   by   "normal   temperature   range,"    and 

what  is  the  normal  range  of  the   dental  pulp? 

25.  Are  destructive  diseases  of  the  pulp  acute  or  chronic? 

26.  Are  they  structural  or  functional? 

27.  Name  some  of  the  destructive  pulp  diseases. 

28.  Define   "hyperaemia"  of  the   pulp. 

29.  What  are  the  two  forms  of  hyperaemia? 

30.  Names  some  causes  of  active  or  arterial  pulp  hyperae- 

mia. 

31.  Give   diagnosis    of   active   hyperaemia   of   pulp,   noting 

especially   the   effect  of  thermal   stimuli. 

32.  What  is  the  prognosis? 

33.  What  is  the  treatment? 

34.  What   are   some   of   the   causes    of   passive   or   venous 

hyperaemia  of  pulp?  * 

35.  Give   diagnosis   of  this   condition. 

36.  What  is  the  prognosis? 

43 


37.  Give  treatment  of  venous  hyperaemia. 

38.  Why  is   the   pulp   of   a  tooth   peculiarly   susceptible   to 

hyperaemia? 

39.  What  is  "pulpitis"? 

40.  What  is  the  essential  feature  of  inflammation  of  pulp  or 

pulpitis? 

41.  How  does  it  differ  from  hyperaemia? 

42.  What  are  the  two  clinical  divisions  of  pulpitis? 

43.  What  are  causes  of  acute  pulpitis? 

44.  In  what  ways  may  bacterial  infection  occur? 

45.  Gdve  morbid  anatomy. 

46.  Does   swelling  ever  occur?     Under  what  conditions? 

47.  G-ive  diagnosis  of  pulpitis. 

48.  Give  prognosis  and  treatment. 

49.  What  is  "suppuration"  of  the  pulp? 

50.  What  are  the  two  clinical  divisions  of  suppuration? 

51.  What  are  the  two  forms  in  which  suppuration  occurs? 

52.  Give  diagnosis  of  ulceration. 

53.  Give  diagnosis  of  abscess  of  pulp. 

54.  What  is  the  prognosis  of  abscess  of  pulp? 

55.  Give   treatment   for   the   latter   condition. 

56.  What  is  the  appearance  of  the  pulp  in  chronic  inflam- 

mation or  sclerosis? 

57.  What  is  "hypertrophy"  of  the  pulp? 

58.  What  is  the  cause  of  this  condition  of  the  pulp? 

59.  With  what  is  this  condition  liable  to  be  confounded? 

60.  Give   treatment. 

61.  Is  tbis  hypertrophied  tissue  usually  very  sensitive? 

62.  Name  some  methods  of  devitalization  of  pulp. 

63.  Describe  method  of  application  of  arsenic  for  this  pur- 

pose. 

44 


64.  With  what  should  the  arsenic  be  combined? 

65.  Is  it  wise  to  apply  arsenic  to  an   inflamed  and  aching 

pulp? 

66.  What  treatment  should   be   instituted   first  under  such 

conditions? 

67.  What   are   the   physiological   effects   of   arsenic   on   the 

pulp? 

68.  What  amount  of  arsenic  should  be  used,  and  how  long 

retained  in  contact  with  pulp? 

69.  What   precautions    should   be   observed   in    making    an 

application   of  arsenic  to   a  pulp? 

70.  Name  some  objections  to  the  use  of  arsenic. 

71.  What  medication    should   be   given   the   pulp   after   re- 

moval ol  arsenic,  and  for  what  purpose? 

72.  Describe   method   of  anaesthetization   of  pulp   with   co- 

caine by  the  use  of  pressure  preparatory  to  its  im- 
mediate removal. 

73.  What  other  drug  may  be  employed  with  pressure  for 

the  purpose  of  destroying  the  pulp? 

74.  What  instruments  are  used  to  remove  the  pulp  tissue 

after    devitalization? 

75.  Describe  method  of  extirpation  of  the  pulp. 

76.  What    antiseptic    precautions    should    be    observed    in 

this    operation? 

77.  What  is  mummification  of  the  pulp? 

78.  How  may  mummification  of  the  pulp  be  accomplished? 

79.  Define  gangrene  of  the  pulp. 

80.  What  are  the  two  forms  in  which  gangrene  of  the  pulp 

occurs? 

81.  Mention  some  causes  of  dry  gangrene. 

82.  Give  pathology  and  morbid  anatomy  of  dry  gangrene. 

45 


83.  What  are  the  symptoms  and  diagnosis  of  dry  gangrene? 

84.  Give  treatment  of  this  condition. 

85.  What  precautions  should  be  observed  in  opening  into 

a  dry  gangrenous  pulp? 

86.  What  are  some  of  the  causes  of  moist  gangrene? 

87.  What  constitutes  the  essential  difference  between  dry 

and   moist   gangrene? 
8S.    Give  diagnosis  of  moist  gangrene. 

89.  Give  the  treatment  for  this  condition. 

90.  What  precautions  are  important  to  be  observed  in  the 

treatment  of  moist  gangrene? 

91.  Into  what  two  general  classes,  according  to  causation, 

may   diseases   of  the   pericementum   be    divided? 

92.  Into  what  three  classes  may  they  be  divided  according 

to  location  of  beginning? 

93.  What  are  the  symptoms  accompanying  inflammation  of 

the  peridental  membrane?* 

94.  Define    "septic    apical    pericementitis." 

95.  What  are  the  two  general  divisions  of? 

96.  What  is   the   most  frequent  cause  of  the   acute  form? 

97.  What  are  the  symptoms  of  acute  septic  apical  pericemen- 

titis? 

98.  Give  clinical  history. 

99.  Describe  procedures  in  diagnosis. 

100.  What  is  the  prognosis  as  to  future  retention  of  tooth? 

101.  Give  treatment  for  this  condition. 

102.  What  are  the  two  forms  of  chronic  septic  apical  perice- 

mentitis? 

103.  What  are  the  symptoms  and  diagnosis  of  this  condition 

when   without  fistula? 

104.  What  name  is  commonly  given  this  condition  when  it 

occurs  without  fistula? 

46 


105.  Give  treatment. 

106.  When   a   case    of   chronic    septic   apical   pericementitis 

refuses  to  yield  to  ordinary  treatment  what  surgical 
procedure  should  he  resorted  to? 

107.  What  is  the  treatment  of  this  condition  when  a  fistula 

is  present? 

108.  What  is  the  prognosis  in  each  case? 

109.  What  is  the  cause  of  the  chronic  form  of  septic  apical 

pericementitis  or  alveolar  abscess? 

110.  Name   some   causes   of   non^purulent   spetic   apical   per- 

icementitis. 

111.  Give  diagnosis  and  treatment  of  this  condition. 

112.  Name  some  causes  of  non-septic  pericementitis. 

113.  Describe    treatment    for    this    condition. 

114.  Name   some   causes  of  pericemental   disease  beginning 

at  the   gum   margin. 

115.  Describe   method  of  enlarging   constricted   pulp   canals 

by  the  use  of  sulphuric  acid. 

120.  How  would  you  determine  when  pulp  canals  are  in  a 

condition   to   be   permanently   filled? 

121.  Under  what  conditions  is  immediate  root  filling  advis- 

able? 

122.  What  materials  are  commonly  employed  for  filling  root 

canals? 

123.  Describe  in  detail  the  method  of  filling  the  root  canal 

with  gutta  perch  a. 

124.  Describe  some  other  method  of  permanently  filling  root 

canals. 


47 


APPENDIX. 

Answers  to  Questions  Marked  With  *. 

No  of 
Page  Question 

10  8     The  fragmentary  remains  of  Nasmyth's  membrane 

retained  at  the  necks  of  teeth  and  in  the  recesses 
of  interproximal  spaces  and  developmental  mark- 
ings, may  catch  and  hold  food  debris  which  by 
fermentation,  would  produce  caries  at  those 
points. 
10  9     Von  Bibra  gives  the  following  analysis  of  enamel: 

Calcium  phosphate  and  fluorid 89.82 

Calcium  carbonate 4.37 

Magnesium  phosphate 1.34 

Other  salts 88 

Cartilage 3.39 

Fat 20 

Total  organic    3.59 

Total  inorganic .96.41 

— American  Text  Book  of  Operative  Dentistry. 
Leon  Williams   claims  to  have  found  no  trace   of 
organic  matter  in  fully  formed   enamel. 

10  21     Von  Bibra  gives  the  following  analysis  of  dentin: 

Organic  nlatter 27.61 

Fat 40 

Calcium  phosphate  and  fluorid 66.72 

Calcium  carbonate    3.36 

Magnesium  phosphate 1-08 

Other  salts 83 

— American  Text  Book  of  Operative  Dentistry. 

11  33     The  functions  of  the  pulp  are: 

Vital — formation  of  dentin  through  odontoblasts. 
Sensory — responds  to  stimuli,  thermal  or  other- 
wise, but  has  no  sense  of  touch. 

11  36  The  alveolo — dental  periosteum,  or  peridental 
membrane  is  a  single  membrane. 

11  37  The  principle  function  of  the  peridental  membrane 
may  be  said  to  be  its  physical  function,  the  means 
of  attachment  between  the  cementum  of  the 
root  of  the  tooth  and  the  alveolar  process. 

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No  of 

Page  Question 

11  38  The  vital  function  of  this  membrane  is  the  forma- 
tion of  both  the  cementum  of  the  tooth  root  and 
the  alveolar  process  through  the  action  of  cemeni- 
oblasts  upon  one  side  and  osteoblasts  upon  the 
other. 

11  39  The  sensory  function  is  the  sense  of  touch  which 
resides  in  this  membrane  only. 

11  40  The  peridental  membrane  belongs  to  the  class  of 
fibrous  membranes  and  is  made  up  of  the  fol- 
lowing elements: 
1.  Fibers.  2.  Fibroblasts.  3.  Cementoblasts.  4. 
Osteoblasts.  5.  Osteoclasts.  B.  Epithelial  struc- 
tures called  glands.  7.  Blood  vessels.  8.  Nerves. 
— F.  B.  Noyes,  Amer.  Text  Book  Op.  Dent. 

Ij^  41  Fibroblasts;  cementoblasts;  osteoblasts;  oste'^ 
clasts. 

11  42  The  fibers  of  the  peridental  membrane  are  at- 
tached to  the  cementum  of  the  root  and  to  the 
aleveolar  process  and  arranged  in  varying  di- 
rections in  such  manner  as  to  best  sustain  the 
tooth  in  its  socket  and  support  it  against  the 
strain  in  mastication.  See  American  Text  Book 
of  Operative  Dentistry,  third  Ed.,  p.  96-102. 

13  1     Dental  caries   may  be    defined  as   the  progressive 

molecular  disintegration  of  the  calcic  and  organic 
tissues  of  the  teeth  in  two  stages;  first,  the  solu- 
tion of  the  calcic  salts  by  means  of  lactic  acid 
-produced  within  the  mouth  by  zymogenic  micro- 
organisms, and  second,  the  dissolution  of  the  or- 
ganic matrix  through  the  agency  of  saprophytic 
fungi. 

13  7     The  most  ancient  human  remains  ever  discovered 

show  evidences  of  the  ravages  of  dental  caries. 
A  mummy  in  the  British  Museum,  dating  back  to 
a  period  about  2800  B.  C.  or  more  than  four  thou- 
sand eight  hundred  years,  shows  undisputed  evi- 
dence of  dental  caries. 

— Marshall. 

13  8     1.  The  Humoral  Theory,  held  456  B.  C.  Hippocrates 

taught  that  the  body  contained  four  humors;  viz., 
blood,  phlegm,  yellow  bile  and  black  bile,  a  dis- 
turbance  of   the   due   proportions   of   which   was 

49 


No  of 
Page  Question 

productive  of  disease.  Dental  caries  was  said 
to  be  caused  by  a  stagnation  of  depraved  juices 
of  the  teeth. 

2.  The    Vital    or    Inflammatory    Theory,    originated 
with   Galen    (A.   D   .,131)    and   was   maintained   by 

various  authorities  down  to  Hertz  and  Abbott  in 
the  latter  part  of  the  nineteenth  century.  It  was 
held  that  dental  caries  was  due  to  inflammation 
within  the  tooth  resulting  in  mortification  or 
gangrene  of  the  dental  tissues  external  to  the 
inflamed  area.  Some  writers  who  advocated  this 
theory  claimed  that  there  was  another  variety  of 
caries  which  began  externally. 

3.  The  Worm  Theory.  Origin  not  known.  It  was 
held  that  the  teeth  were  destroyed  by  worms. 
Probably  practiced  as  a  deception  as  it  is  to  the 
present  day  in  China,  where  native  dentists  pre- 
tend to  extract  the  worms  (artificial)  from  aching 
teeth,  thus  relieving  their  wondering  but  satisfied 
patients. 

4.  The  Putrefaction  Theory.  First  announced  by 
Pfaff  (1756)  who  claimed  that  destruction  of 
teeth  by  caries  was  due  to  putrefaction  of  re- 
mains of  food  upon  them;  approaches  the  truth 
but  fails  to  recognize  the  agency  of  bacteria. 

5.  The  Chemical  Theory.  Though  suggested  vaguely 
by  several  ancient  writers,  the  chemical  theory 
of  dental  caries  is  modern  and  was  generally 
accepted  up  to  the  time  of  Miller's  experiments 
published  in  1882.  According  to  this  theory  the 
destruction  of  teeth  by  caries  was  attributed  to 
the  solvent  action  of  acids.  Watts  was  the  most 
conspicuous  advocate  of  this  theory.  He  held 
that  three  mineral  acids,  hydrochloric,  sulphuric 
and  nitric  were  the  sole  agencies  of  caries;  the 
nitric  acid  producing  the  rapid  white  variety,  the 
sulphuric  the  black  and  the  hydrochloric  the  inter- 
mediate shades  of  caries. 

6.  The  Electro  Chemical  Theory.  Bridgman  (1861- 
63)  promulgated  the  theory  that  a  tooth  in  a  liv- 
ing body  was  always  polarized,  the  root  invested  in 
the  gum  and  alveolas  being  electro-positive,  while 

50 


No  of 
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the  crown  exposed  to  the  atmospnere  was  electro- 
negative, thus  constituting  a  miniature  galvanic 
battery  the  current  thus  set  up  decomposing  the> 
saliva  holding  in  solution  food  particles,  forming 
acids  which  attacked  the  tooth  tissues.  The 
electro  chemical  theory  was  adopted  by  what  was 
known  as  the  "New  Departure  Corps"  and  offered 
as  an  explanation  of  secondary  carles  about 
fillings.  Through  a  long  line  of  experiments  to 
establish  the  position,  in  the  electro-chemical 
series,  of  dentin  with  the  various  filling  materials, 
it  was  shown  that  gold  was  the  most  incompatible 
with  dentin,  amalgam  next,  then  tin,  gutta  percha 
and  the  oxide  of  zinc  cements  in  the  order 
named. 
7.  The  Germ  Theory..  Though  many  earlier  investi- 
gators foreshadowed  in  their  writings  the  agency 
of  germs  in  the  production  of  caries  of  the  teeth, 
it  was  not  until  this  theory  was  positively  demon- 
strated by  Dr.  W.  D.  Miller  of  Berlin  that  it  was 
generally  accepted  as  an  established^  truth. 

13  16  A  tube  containing  a  solution  of  starch  was  fastened 
to  a  molar  tooth  upon  retiring.  In  the  morning 
contents  of  tube  strongly  acid.  A  tube  of  starch 
solution  with  saliva  added  was  incubated  at  blood 
temperature.  After  four  or  five  hours  the  mixture 
became  acid.  The  conclusion  was  that  the  acid 
was  the  result  of  fermentation  produced  by  germs. 

13  17  The  starch  was  heated  to  100  cC,  sufficient  to 
destroy  any  germs  present,  saliva  being  added 
and  the  mixture  kept  in  an  incubator  at  blood 
heat,  acid  was  produced.  The  saliva  was  boiled 
and  upon  repeating  the  experiment  no  acid 
resulted.  The  conclusion  was  that  the  germs 
resided  in  the  saliva. 

13  18  The  germs  were  shown  to  be  reproductive  by 
inoculating  a  fresh  culture  medium  from  an  in- 
fected tube  when  the  germs  were  seen  to  rapidly 
multiply. 

13  19     By  chemical  analysis  the  acid  produced  was  shown 

to  be  lactic. 

14  31     Micro-organisms  which  can  only  exist  in  the  pres- 

ence of  oxygen  are  called  "aerobic."     Those  cap- 
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No  of 
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able  of  existing  without  oxygen  are  called 
"anaerobic."  Those  which,  in  the  normal  state 
thrive  in  the  presence  of  oxygen  but  which  are 
capable  under  changed  conditions  of  existing 
without  oxygen,  are  said  to  be  "facultative 
anaerobic." 
15         40     The  predisposing  causes  of  caries. 

1.  Faulty   formation.     Those   relating    to    external 
form;   those  relating  to  internal  structure. 

2.  Manner  of  approximal  contact. 

3.  Malposition. 

4.  Heredity. 

5.  Morbid  condition  of  oral  fluids. 

6.  Sickness. 

7.  Pregnancy. 

8.  Artificial -dentures. 

9.  Lack  of  cleanliness. 

10.  Lack  of  exercise. 

15.  41  Dr.  Marshall  enumerates  as  constitutional  predis- 
posing causes  of  caries: 

1.  Environment. 

2.  Climatic  influences. 

3.  Miscegenation. 

4.  Excessive  mental  strain  in  growing  children. 

5.  Hereditary  influence. 

6.  Influence  of  inherited  disease. 

7.  Exanthematous  disease. 

8.  Continued  fevers. 

18  15  Salicylic  acid  is  an  effective  and  safe  antiseptic. 
What  is  known  as  Thiersch's  antiseptic  solution 
is  composed  of  salicylic  acid  four  parts;  boric 
acid,  twelve  parts;  water,  one  thousand  parts. 
Flavor  to  suit  the  taste  with  oil  of  cassia,  pepper- 
mint   or    wintergreen. 

18  -  24  The  Stopping  Process  may  be  defined  as  any  method 
of  treatment  of  dental  caries  which  effects  the 
removal  of  the  carious  matter  and  substitutes 
therefor  some  material  possessing  such  inherent 
physical  properties  as  render  it  capable  of  intro- 
duction into  all  parts  of  the  resultant  cavity  and 
of  protecting  its  margins  and  inner  'surface  from 
further  destructive  influences. 
— Dr.  Louis  Jack  in  American  System  of  Dentistry. 
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19  36  Dr.  Louis  Jack  in  The  American  System  of 
Dentistry  says  that  to  be  a  skillful  operator  "in- 
volves a  knowledge  of  the  chemical  and  physical 
properties  of  (filling)  materials,  a  general  knowl- 
edge of  physics,  a  correct  eye  for  good  forms,  a 
clear  judgment,  and,  moreover,  a  sensitive  and 
well  trained  hand." 
25  12  Dr.  G.  V.  Black  has  arranged  cavities  in  groups 
according  to  similarity  of  treatment  in  prepar- 
ation for  convenience  of  study.  His  arrangement 
is  in  five  groups  or  classes.  The  sixth  I  ha^e 
added. 

Class  1.  Cavities  beginning  in  structural  defects 
in  the  teeth,  as  pits  and  fissures. 

Class  2.  Cavities  in  the  gingival  third — not  pit 
cavities — of  the  labial,  buccal  or  lingual  surfaces 
of  the  teeth. 

Class  3.  Cavities  in  the  proximate  surfaces  of  the 
incisors  and  cuspids  which  do  not  involve  the 
removal  and  restoration  of  the  mesial  or  distal 
angle. 

Class  4.  Cavities  in  the  proximate  surfaces  of  the 
incisors  and  cuspids  which  do  require  the  removal 
and  restoration  of  the  mesial  or  distal  angle. 

Class  5.  Cavities  in  the  proximate  surfaces  of  the 
bicuspids  and  molars. 

Class   6.     Abraded   surfaces. 

25  13     Cavities  are  also  divided  into  two  great  groups,  pit 

and  fissure  cavities  and  abraded  surface  cavities 
forming  one  group,  and  classes  2,  3,  4  and  5  form- 
ing another  group  of  cavities  upon  smooth  sur- 
faces habitually  unclean. 

26  17     The  four  steps  in  cavity  preparation  are  as  follows: 

1.  Gaining  access. 

2.  Removal  of  soft  carious  matter. 

3.  Obtaining  retention  and  resistance  forms. 

4.  Cavity  toilet,  and  management  of  enamel  mar- 
gins. 

2G         22     Dr.  Black's  rules  for  preparation  of  enamel  margins 
as  arranged  by  Dr.  W.  E.  Grant  are  as  follows: 
Rule  1.    Extend  the  cavity  margins  in  every  direc- 
tion until   sound  enamel  is  reached. 

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No  of 
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Rule  2.     If  necessary,  further  extension  should  be 
made  until  full  length  enamel  rods  supported  by 
dentin  are  reached. 
Rule  3.     Cut  away  the  enamel  until  the  surface  of 
the  filling  can  be  so  formed  that  the  enamel  mar- 
gin will  be  self-cleasing  or  be  protected  by  the 
gum  margin. 
Rule  4.     Do  not  form  an  enamel  margin  in  such  a 
position  as  to  leave  a  small  portion  of  enamel  be- 
tween it  and  one  of  the  developmental  grooves. 
Rule  5.    A  fissure,  sulcate  or  angular  developmental 
groove    should   be   cut   in   its   entire   length   and 
included  in  the  cavity. 
Rule  6.    The  line  of  the  enamel  margins  should  be 
in  definite  curves  or  straight  lines,  avoiding  all 
angles. 
Rule   7.     The   labial,   buccal,   and   lingual   margins 
should    be   parallel   to   each   other   and   at   right 
angles  to  the  seat  of  the  cavity. 
Rule  8.    All  margins  should  be  cut  smooth,  and  after 
applying  the  above  rules,  should  be  beveled  in 
such   a  manner  as  to  leave  the  marginal  edges 
slightly  obtuse. 

26  32  By  the  term  "crushing  strain"  is  meant  the  force  of 
mastication  brought  directly  upon  the  exposed 
surface  of  the  filling  and  through  it  to  the  seat 
of  the  cavity. 

26  33  In  occlusal  cavities  the  pulpal  wall  constitutes  the 
"seat."  In  proximate  cavities  the  gingival  wall 
and  in  case  of  complex  cavities  with  occlusal  or 
incisal  step,  the  gingival  wall  plus  the  step  con- 
stitute the  seat. 

26  34  An  extension  from  an  axial  cavity  upon  the  incisal 
or  occlusal  surface  for  the  purpose  of  gaining 
resistance  form  is  called  the  "step"  of  such 
cavity. 

26  35  The  seat  must  be  flat  and  at  right  angles  to  the 
long  axis  of  the  tooth  and  direction  of  the 
strain. 

26        36     By   the  term   "extension  for  prevention"  is  meant 
the   extending  of  cavity  margins,   upon   smooth, 
unclean  surfaces,  from  an  area  of  great  liability 
to  caries  to  an  area  of  lesser  liability. 
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26  37  "Affected  dentin"  is  dentin  which  has  been  acted 
upon  by  the  lactic  acid  in  advance  of  the  micro- 
organisms of  caries. 

26  38     "Infected   dentin"  is   dentin  which  has  been  pene- 

trated by  the  micro-organisms  of  caries. 

27  39     The  four  varieties  of  carious  matter  are:    1.  Horn- 

like, occurring  at  the  necks  of  teeth.  2.  Leath- 
ery, found  usually  in  young  teeth.  3.  Soft  or 
cheese-like,  a  light  colored  variety  of  rapid  pro- 
gress. 4.  Dry  or  hard,  dark  in  color  and  of  slow 
progress,  sometimes  spontaneously  arrested. 

27  46     Rule  1.  When  the  depth   of  cavity  is   equal  to  or 

greater  than  the  width,  parallel  walls  are  suffi- 
cient for  retention  in  cavities  of  class  one,  and 
class  two. 
Rule  2.  When  width  of  cavity  is  greater  than  the 
depth  some  undercutting  is  necessary. 

28  60     By   Convenience  Form   is   meant   such   shaping  of 

the  cavity  outline  as  will  render  the  form  more 

convenient   for   packing   the   filling   material,   or 

the  placing  of  slight  undercuts  or  angles  in  the 

cavity   walls    as    starting   points   for   the   filling. 

—Black. 

30        87     A  good  rule  as  to  the  extent  of  the  extension  (for 

prevention,  in  cavities  of  class  5)   is  to  cut  the 

lingual  wall  to  a  line  where  its  margin  will  be 

in  view,  past  the  proximating  tooth  when  looking 

across   the   central   incisors   at   the  median  line, 

and   make   the   extension  of  the  buccal   wall   to 

correspond. 

—Black. 

The  above  applies  to  a  mesial  cavity  in  an  upper 
first  molar  and  will  serve  as  a  guide  as  to  exten- 
sion in  other  cavities  of  this  class. 
32  1     The  four  general  objects  in  view  in  filling  carious 

teeth  are: 

1.  To  arrest  existing  decay. 

2.  To  preserve  from  future  attacks  of  caries. 

3.  To  provide  against  stress  of  mastication. 

4.  To  restore  full  form  of  tooth. 

32  2     The  points  to   be  taken  into   consideration  in   the 

selection  of  a  filling  material  are:     The  age  of 

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the  patient,  the  sex,  condition  of  health,  character 
of  the  teeth  and  the  oral  secretions,  the  evident 
care  bestowed  upon  the  teeth,  and  the  life  expec- 
tancy of  the  individual  or  of  the  tooth. 

33         11     Fillings   may  be  said  to  preserve   teeth  in  one  of 
four  ways. 

1.  By  perfect  exclusion  of  the  oral  fluids. 

2.  By  deposit  of  metallic  salts. 

3.  By  therapeutic  or  medicinal  effects. 

4.  By  non-conduction  and  non-irritation. 

33  14  Dr.  C.  X.  Johnson  has  pointed  out  that  gold  is  much 
less  objectionable  in  color  when  exposed  to  view 
in  the  anterior  teeth,  in  the  mouths  of  some 
individuals  than  in  others.  He  says:  "It  will 
be  found  that  decided  blondes  will  tolerate  gold 
.  in  their  anterior  teeth  with  less  objection  than 
will  brunettes.  In  fact,  the  color  of  gold  harmon- 
izes so  well  with  the  former  that  if  a  filling  is 
well  inserted  there  is  nothing  to  offend  the  eye 
at  a  distance  of  several  feet.  On  the  other  hand, 
a  gold  filling  in  the  mouth  of  a  brunette  becomes 
at  once  conspicuous  and  objectionable." 

33  19     Dr.   Arthur    in    1855     accidentally    discovered    the 

cohesive  property  of  pure  gold  and  at  once  began 
to  experiment  with  it  and  devised  means  to 
regulate  and  make  intelligent  use  of  it. 

34  32     Annealing  gold   makes   it   cohesive   by   driving   off 

from  its  surface  any  volatile  or  combustible  im- 
purity and  probably  also  by  a  rearrangement  of 
its  molecules  by  the  heat. 

34  33  Gold  may  be  rendered  permanently  non-cohesive 
'by  depositing  upon  its  surface  some  substance 
which  cannot  be  volatilized  or  burned  off.  It  is 
well  known  that  Abbey's  foil  cannot  be  made  co- 
hesive by  annealing,  the  impurity  upon  its  sur- 
face being  non-volatile;  probably  some  form  of 
iron. 

34  34  The  Sulphur  and  Phosphorus  groups,  as  pointed  out 
by  Dr.  Black,  are  especially  injurious  to  gold. 

34  35  These  gases  are  present  in  the  atmosphere  espe- 
ially  in  winter,  and  also  many  reach  the  gold  from 
the  use  of  sulphur  matches. 

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34  36  Dr.  Black  advises  that,  since  acid  gases  are  found 
to  be  most  likely  to  permanently  destroy  the  co- 
hesive property  of  gold,  the  gold  should  be  kept 
in  an  atmosphere  containing  a  liberal  per  cent 
of  ammonia,  which  by  forming  ammonium  salts 
on  the  gold  surface  will  protect  it  from  acid 
gases.  The  ammonium  salts  being  readily  volatil- 
ized by  heat,  the  gold  may  at  any  time  be  made  co- 
hesive by  annealing.  For  this  purpose  an  open 
bottle  of  salts  of  ammonia  should  be  kept  in  the 
drawer  containing  the  gold. 

34        42     The  retention  of  gold  in  a  cavity  depends  upon  the  ^ 
retentive  form  of  the  cavity  and  the  proper  ar- 
rangement or  packing  of  the  gold  into  the  cavity. 

34  43  The  three  methods  of  packing  gold  into  a  cavity 
are: 

1.  By    mechanical    arrangement,    employed    when 
using  non-cohesive  gold. 

2.  By  incorporation,   employed  when  cohesive   and 
non-cohesive  gold  are  used  in  combination. 

3.  By  cohesion,  employed  when  cohesive  gold  alone 
is  used. 

— Dr.  Louis  Jack,  American  System  of  Dentistry. 
34        45     The  resistances  to  be  overcome  in  packing  gold  into 
a  cavity  are: 

1.  Natural  rigidity  of  the  gold. 

2.  Confinement   of   air   particles    in    the    folds    or 
meshes  of  gold. 

3.  Friction  of  one  piece  of  gold  upon  another  and 
upon  the  cavity  walls. 

4.  The  crimpling  of  the  gold. 

— Dr.  Louis  Jack  in  American  System. 

34  46     The  forces   applied  to  overcome  these  resistances 

are: 

1.  Direct   pressure. 

2.  Wedging. 

3.  Leverage. 

4.  Percussion. 

— Dr.  Louis  Jack. 

35  53     The  three  objects  to  be  borne  in  mind  in  packing 

gold  into  a  cavity  are:. 
1.  Adaptation   to   cavity  walls   and  margins. 

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2.  Form  of  external  surface. 

3.  Density  of  the  mass. 

— Dr.  Louis  Jack. 

36  63     The  impacting  power  of  a  plugger  point  under  a 

given  amount  of  force  is  in  indirect  ratio  to  the 
size  of  the  plugger  point.  That  is,  the  smaller 
the  plugger  point  the  greater  its  impacting  power 
under  the  same  applied  force.  The  area  of  a 
plugger  point  is  practically  the  square  of  its 
diameter.  A  reduction  of  the  size  of  a  plugger 
point  below  say,  one  millimeter,  increases  the  con* 
densing  power  of  the  impact  in  proportion  to  the 
square  of  the  reduced  area  and  increasing  the 
size  of  the  point  above  one  millimeter  diminishes 
the  condensing  power  of  the  impact  in  propor- 
tion to  the  square  of  the  increased  diameter. 
To  make  solid  fillings  therefore,  small  condensing 
points,  not  more  than  one  square  millimeter  in 
area,  should  be  used. 

Dr.  G.  V.  Black. 

37  91     About  the  year  1826  M.  Teveau  of  Paris  introduced 

what  he  called  "silver  paste,"  consisting  of  pure 
silver  and  mercury. 
37         92     Amalgam  was  introduced  into  this  country  in  1833 
by  the  Crawcour  brothers  under  the  name  "Royal 
Mineral  Suocedaneum." 

— ^American  System  of  Dentistry,  Vol.  II. 

37  97     The  physical  properties  of  amalgam  are: 

1.  That  of  hardening. 

2.  Expansion  and  contraction. 

3.  Flow. 

4.  Edge  strength. 

5.  Color. 

38  100     Dr.  Black  has  shown  that  contraction  and  expansion 

are  influenced  by 

1.  The  composition  of  the  alloy. 

2.  The  fineness  of  the  cut  of  the  alloy. 

3.  The  amount  of  mercury  used  in  amalgamation. 

4.  The  evenness  with  which  the  mercury  is  distri- 
buted, 

5.  The  method  of  manipulation. 

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38  102  Dr.  Black  was  the  first  to  observe  and  to  call  atten- 
tion to  the  tendency  of  amalgams  to  flow  or 
flatten  under  stress.  Most  metals,  as  was  well 
known,  will  yield  to  a  given  pressure  up  to  a 
certain  point  and  then  cease,  beginning  again 
to  yield  when  pressure  is  increased  and  again 
ceasing.  Amalgams,  on  the  contrary,  continue  to 
yield  as  long  as  pressure  is  continued  even 
though  it  be  not  increased.  There  is  manifest 
a  disposition  of  the  material  to  creep  out  from 
under  a  load.  This  fact  explains  tiie  bulging 
of  amalgam  fillings  when  exposed  to  occlusal 
stress,  a  portion  of  the  filling  being  unconfined 
upon  an  axial  surface;  a  phenomenon  often  ob- 
served in  the  mouth. 

38  106  In  the  course  of  his  experiments  Dr.  Black  observed 
that  the  age  of  cut  alloys  had  a  marked  influence 
upon  the  ph^'sical  properties  of  their  amalgams, 
especially  those  of  expansion  and  contraction.  By 
annealing  freshly  cut  alloys,  thus  producing  an 
artificial  ageing,  they  were  brought  into  a  state 
of  stability  so  that  their  amalgams  always  showed 
uniform  and  constant  properties. 

38  107  Annealing  of  alloys  is  accomplished  by  subjecting 
them,  when  freshly  cut,  to  either  dry  or  moist 
heat  ranging  from  110-  to  212  ^F.  and  continued 
for  some  hours.  The  lower  temperatures  pro- 
duced the  best  results. 

38  108.  Annealing  of  alloys  has  the  effect  of  increasing 
the  contraction,  flow  and  edge  strength  or  crush- 
ing strain  of  the  amalgam,  they  require  less  mer- 
cury for  amalgamation  and  the  amalgam  sets 
slower. 

38       112     According  to  Dr.  Black  the  effect  of  modifying  the 
silver-tin  alloy  with  the  addition  of  5  per  cent  of 
some  other  metals  is,  in  part,  as  follows: 
Gold  added  5  per  cent.  Slows  setting. 

Flows  more. 
Takes    less    mercury. 
Crushing  stress  increased. 
Shrinkage  reduced. 

Platinum  added  5  per  cent.     Darkens. 

Slows  setting  considerably. 
Flows  badly. 

Shrinkage  —  expansion     range 
increased. 

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Copper  added  5  per  cent.    Sets  quickly. 

Annealed  sets  slower. 
Expansion   increased. 
Flow   diminished. 
Crushing  stress  greatest  of  all. 
Zinc  added  5  per  cent.    Great  expansion,  very  slow 

but  long  continued. 
Apparent  adhesion  to  walls. 
Sets    quicker — less    when    an- 
nealed. 
Flow  decidedly  increased. 
Color  improved. 
Crushing  strength  increased. 
Takes  more  mercury. 
—Dr.  G.  V.  Black,  Cosmos  1896,  p.  988. 
39      116    Dr.  Black  found  the  following  formula  to  give  the 
most  successful  results: 
Ag.  68.5,  Sn.  25.5,  Au.  5.  Zn.  1,  or,  substituting  cop- 
per for  the  gold,  Ag.  68.  Sn.  26.  Au  5.  Zn.  1. 
46         93     The  symptoms  accompanying  inflammation  of  the 
peridental  membrane  are: 

1.  Tenderness   upon   percussion. 

2.  Dull  percussion  note. 

3.  Protrusion   and  looseness   of  tooth. 
5,  Heightened  gum  color. 


60 


THE    HOLLOW   GOLD    INLAY— DESCRIPTION    IN    DETAIL 
OF    ITS   CONSTRUCTION. 

The  gold  inlay  is  chiefly  applicable  to  large  cavities  in 
molars  and  bicuspids,  though  it  may  occasionally  be  employed 
to  advantage  in  other  localities.  In  small  and  medium  sized 
cavities  on  the  occlusal  or  axio-occlusal  surfaces  which  may 
be  readily  filled  in  the  ordinary  way,  the  gold  inlay  is  not 
indicated.  In  medium  sized  cavities,  however,  the  deter- 
mination of  choice  of  inlay  or  filling  would  be  governed  by 
the  character  of  the  tooth  tissues,  the  sensitiveness  of  the 
peridental  membrane  to  percussion,  and  the  physical  condition 
of  the  patient.  In  very  large  complex  cavities, .  the  extent 
to  which  restoration  may  be  attempted  and  successfully 
accomplished  by  means  of  a  gold  inlay  is  almost  unlimited. 
Almost  the  entire  crown  may  frequently  be  thus  rebuilt  to 
better  advantage,  the  health  and  comfort  of  the  adjacent 
tissues  considered,  than  by  means  of  a  banded  crown.  The 
term  "inlay"  however,  demands  that  there  must  be  enough 
of  the  natural  crown  remaining  to  receive  within  a  cavity 
formed  in  its  substance,  the  prosthetic  device  employed  to 
restore  the  lost  portion.  The  class  of  cavities  most  frequently 
selected  for  gold  inlays  are  those  complex  cavities  involving 
one  or  more  axial  surfaces  and  the  occlusal.  For  the  purpose 
of  description  we  will  select  a  cavity  involving  the  entire 
mesial  surface  of  a  lower  first  molar,  the  buccal  and  lingual 
walls  denuded  of  dentin  and  quite  frail  and  the  occlusal 
wall  broken  in.  The  first  step  is  to  boldly  cut  away  the 
buccal  and  lingual  walls  with  a  chisel.  Here  we  practice 
extension  for  prevention  heroically  and  are  not  deterred  in  so 
doing  by  the  thought  of  the  labor  it  will  involve  to  restore 
the  contour  by  the  tedious  malleting  of  cohesive  gold.  With 

61 


a  gold  inlay  it  is  as  easy  to  restore  a  large  contour  as  a  small 
one.  So  we  cut  these  walls  back  until  they  lie  in  sound 
tissue  and  until  all  over-hang  so  far  as  is  possible,  has  been 
removed.  The  margins  should  be  cut  in  straight  lines  and 
carefully  smoothed  and  bevelled.  The  step  on  the  occlusal 
surface  must  include  all  developmental  grooves,  must  be 
made  flat  and  with  surrounding  walls  perpendicular  to  the 
floor  or  leaning  slightly  away  from  the  perpendicular  and  with- 
out undercuts.  If  following  the  natural  lines  of  fissured 
grooves  does  not  give  the  step  the  general  effect  of  a  dove 
tail,  such  form  must  be  given  to  it  by  broadening  the  step 
towards  the  distal  extremity.  It  is  important  that  an  inlay 
shall  be  retained  against  mastication  stress  by  the  shape  of 
the  cavity  alone,  tne  cement  serving  the  purposes  only  of 
hermetically  sealing  the  cavity  and  holding  the  inlay  from 
falling  out  or  being  lifted  out  occlusally  the  way  it  was  put  in. 
The  cavity  must  now  be  viewed  carefully  by  direct  vision 
and  by  reflection  in  a  plane  month  mirror  so  as  to  be  able 
to  look  squarely  down  into  it  to  determine  if  all  undercuts 
have  been  elminated.  If  there  are  any  undercuts  which  cannot 
be  eliminated  without  too  much  destruction  of  tooth  tissue 
they  may  be  filled  with  cement  which  is  to  be  removed  again 
just  previous  to  setting  the  finished  inlay  that  the  fresh 
cement  may  secure  the  additional  grasp  upon  the  tooth  that 
such  undercuts  afford.  If  there  should  be  any  doubt  as  to 
the  cavity  having  been  given  the  proper  form  to  "draw"  freely, 
that  point  may  be  determined  by  pressing  into  the  moist 
cavity  a  piece  of  softened  modeling  compound  which  is  chilled 
and  upon  withdrawing  will  show  just  where  further  trimming 
is  needed.  A  piece  of  pure  gold  plate  36-gauge  or  thinner  is 
cut  of  such  size  as  to  be  ample  for  the  purpose  but  not  so 
bulky  as  to  be  in  the  way;  one  edge  is  trimmed  to  a  curve 
like  the  edge  of  a  matrix  band  and  this  edge  is  slipped  down 
below  the  gum  margin  at  the  gingival  cavity  wall  and  being 
held  with  one  hand  the  gold  is  forced  into  the  cavity  and 
against  the  axial  wall  preferably  with  a  pair  of  ball  pointed 

62 


pliers  shaped  like  foil  carriers,  and  a  pledget  of  wet  cotton 
or  punk.  The  gold  is  now  adapted  to  the  axial  portion  of  the 
cavity  with  suitable  burnishers,  one  being  used  in  the  left 
hand  as  an  assistant  to  hold  the  piece  firm  while  being 
manipulated  by  the  one  in  the  other  hand.  As  soon  as  the 
gold  begins  to  harden  and  grow  springy  under  the  burnishing, 
it  should  be  removed  and  annealed  by  heating  to  redness,  and 
this  must  be  done  frequently  while  adapting  this,  the  matrix 
piece.  When  the  matrix  has  been  fairly  well  adapted  to 
the  axial  portion  of  the  cavity,  wet  cotton  is  packed  tightly 
into  that  part  of  the  cavity  and  against  the  approximating  tooth, 
thus  holding  the  gold  immovable  while  the  occlusal  portion  is 
carefully  carried  over  and  adapted  to  floor  and  walls  of 
the  step.  The  adjustment  to  the  floor  of  the  step  should  be 
completed  with  a  circular  flat  ended  burnisher  like  an  in- 
verted cone  bur  of  a  size  suited  to  the  size  of  the  fissures  an-d 
the  gold  carried  into  every  part  of  the  step.  In  nar- 
row deep  fissures  the  gold  will  probably  be  punctured  in 
which  case  and  when  not  punctured  as  well,  crystal  gold 
should  be  packed  tightly  into  these  fissures,  the  cotton  re- 
moved from  the  axial  portion,  the  matrix  skillfully  teased  up 
and  lifted  out  and  some  22-karat  gold  melted  with  a  blow- 
pipe into  the  crystal  gold.  When  replaced  in  the  cavity  this 
stiffened  step  holds  firmly  to  its  place  while  the  axial  portion 
is  accurately  adapted  and  all  margins  smoothed  nicely  over 
with  a  flat  slender  burnisher.  The  matrix  is  again  removed 
and  trimmed  with  curved  shears  following  the  outline  of  the 
cavity  and  leaving  an  overlap  all  around  about  one  millimeter 
in  width.  This  excess  of  gold  around  the  margins  is  impor- 
tant as  will  be  seen  later.  A  small  hole  is  now  punched  with 
a  plate  punch  in  the  center  of  the  axial  portion  of  the  matrix 
which  is  again  placed  in  the  cavity  and  any  distortion  cor- 
rected. 

The  next  step,  the  arrangement  of  the  outer  piece  of  gold 
and  the  formation  of  the  contour,  appears  at  first  sight  to  be 
quite  diflBcult,  but  in  most  cases  it  is  very  simple.  A  piece 
of  the  same  thickness  of  pure  gold  is  cut,  large  enough  to 

63 


extend  well  out  into  the  embrassures,  buccal  and  lingual, 
and  to  reach  over  upon  the  occlusal  as  far  as  will  be  needed. 
This  is  trimmed  along  one  edge  to  fit  within  the  line  on  the 
matrix  piece  which  marks  the  gingival  margin,  but  is  not 
allowed  to  lap  over  upon  the  excess  left  along  that  margin. 
The  two  pieces  are  now  held  together  with  a  pair  of  long, 
slender  solder  tweezers  in  such  manner  that  the  edge  of  the 
outside  piece  is  kept  in  contact  with  the  line  of  the  gingival 
margin  and  is  there  tacked  with  a  tiny  piece  of  22-karat  gold. 
Thus  is  formed  in  effect,  a  hinge,  and  gives  a  fixed  point  as 
a  base  from  which  to  develop  the  desired  contour.  The 
pieces  thus  assembled  are  replaced  in  the  cavity  and  pledgets 
of  wet  cotton  are  packed  between  them  forcing  the  outer  piece 
of  gold  out  to  the  desired  contact  with  the  approximating 
tooth.  The  gold  is  then  bent  over  upon  the  occlusal  surface, 
smoothed  down  somewhat  with  an  egg  shaped  burnisher  and 
the  patient  instructed  to  close  tightly  upon  it  thus  forcing 
the  thin  gold  into  proper  articulating  form.  The  piece  is  now 
removed  and  with  a  pair  of  small,  pointed,  curved  shears  the 
bucco — and  linguo — occlusal  angles  are  slit  far  enough  to 
permit  of  proper  shaping  of  those  corners,  and  the  outer 
piece  trimmed  all  around  so  that  its  margin  falls  within  the 
excess  provided  on  the  matrix  piece,  and  as  nearly  as  possible 
along  the  true  margin  of  the  cavity  clearly  shown  on  the 
matrix.  This  arrangement  makes  the  placing  of  the  solder 
easier  and  provides  an  overlap  of  thin  pure  gold  for  final 
burnishing  when  the  inlay  is  set. 

The  piece  is  again  returned  to  the  cavity  and  the  margins 
carefully  smoothed  down  to  contact  and  the  slit  corners  so 
manipulated  as  to  properly  form  the  bucco — and  lingo — occlu- 
sal angles.  It  is  now  removed,  opened  by  bending  the  outer 
piece  back  upon  the  hinge  at  the  gingival  margin,  the  cotton 
removed,  the  parts  brought  back  into  position  again  and 
being  grasped  with  the  long  tweezers  at  the  disto-occlusal 
extremity,  the  margins  are  soldered  with  a  blow-pipe  using 
small  pieces  of  22-karat  plate  for  the  purpose.  It  may  now 
be  tried  in  the  cavity  again  to  see  that  everything  is  as  it 

64 


is  desired  it  should  be.  Any  irregularities  caused  by  the 
gold  crimping  may  be  smoothed  up  perfectly  or  any  desired 
additions  to  the  outside  can  be  now  made  by  fusing  pieces  of 
22-karat  plate  upon  such  places  with  a  mouth  blow-pipe.  With 
curved  shears  the  little  punch  hole  in  the  matrix  piece  is  cut 
to  a  circular  or  oblong  hole  about  1-8  inch  in  diameter,  and 
through  this  hole  pieces  of  22-karat  or  20-karat  solder  are 
dropped,  a  little  powdered  borax  put  in,  being  careful  that 
no  borax  is  left  on  the  outside  of  matrix,  and  the  solder  fused 
by  holding  in  the  flame  of  a  Bunsen  burner,  so  directing  the 
flow  of  the  fused  metal  by  gravity  that  the  step  is  filled  first. 
This  is  repeated  until  the  space  within  is  almost  but  not  quite 
full,  a  cavity  being  left  just  within  and  about  the  hole  for  the 
cement  to  enter  and  help  hold  the  inlay  in  place  when  set. 
This  opening  being  opposite  to  the  point  of  nearest  approach 
to  the  pulp  of  a  vital  tooth  will  afford  an  appreciable  protec- 
tion to  that  organ  from  thermal  shocks.  After  the  last  fusing 
the  piece  should  be  dropped  hot  into  a  50  per  cent  solution 
of  sulphuric  acid  to  remove  all  borax. 

The  approximal  surface  of  the  inlay  is  filed  smooth  and 
polished  before  setting  so  that  that  surface  need  not  be 
touched  afterwards. 

The  cavity  and  the  inlay  are  thoroughly  dried  with  alcohol 
and  warm  air,  cement  mixed  to  a  thick  cream  is  worked 
deftly  into  the  hole  in  the  inlay  from  one  side  so  as  to 
expel  the  air,  the  matrix  is  covered  over  with  the  cement  and 
the  inlay  inserted  into  the  tooth  cavity,  pushed  firmly  to 
place  and  while  held  under  pressure  with  a  convex  faced 
burnisher  the  overlapping  margins  are  burnished  close  to  the 
tooth  all  around.  When  the  cement  has  hardened  the  occlusal 
portion  is  finished  just  as  a  gold  filling  would  be,  and  the 
buccal  and  lingual  margins  appearing  in  the  embrassures  are 
polished  with  fine  sand  paper  or  cuttle  bone  disks. 

If  the  inlay  has  been  properly  made  and  set  there  is  no 
where  to  be  seen  any  cement,  the  -overlapping  edge  of  pure 
gold  affording  perfect  protection  against  any  possibility  of 
cement  being  dissolved  out. 

65 


In  cases  of  cavities  so  located  as  to  make  it  diflficult  or 
impossible  to  burnish  the  matrix  directly  into  the  cavity, 
an  impression  of  tooth  and  cavity  can  be  taken  in  modeling 
compound,  the  impression  being  filled  with  quick  setting 
amalgam  as  described  in  a  former  paper  published  in  "The 
Cosmos"  for  August,  1902.  If  copper  amalgam  is  employed  it 
can  be  used  over  and  over.  The  matrix  is  eas'ily  adapted  to 
such  a  model  and  being  readily  corrected  in  the  cavity  itself, 
the  rest  of  the  process  is  not  more  difficult  than  in  cavities 
of  easy  access. 

Where  the  countour  restoration  is  considerable  it  may  be 
advisable  to  build  out  and  carve  the  contour  with  hard  wax 
from  which  a  metal  die  is  made  and  the  outside  piece  struck 
up  in  a  Ransom  &  Randolph  or  some  other  crown  swager. 

With  experience  and  practice  in  this  method  of  construct- 
ing gold  inlays,  it  will  be  found  that  the  need  of  an  impression 
to  aid  in  forming  the  matrix  or  of  swaging  the  contour  piece 
will  grow  less  and  less. 

Borax  to  be  used  for  soldering  should  be  first  thoroughly 
fused  on  a  thick  porcelain  dish,  (a  heavy  soap  dish  is  best) 
and  then  ground  to  powder  in  a  Wedgewood  mortar.  Borax 
treated  in  this  way  will  not  swell  up  while  soldering  and 
displace  the  pieces  of  solder. 


66 


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